Management of delirium

While the search for cause of delirium is critically important, organ failure and metabolic disorders may not be correctable and one must manage the delirium recognizing that one cannot eliminate the cause. With pain medications, they can often be titrated or switched to another, but the delirious side-effects may have to be managed. Patients and families should be reassured about the fact that they are not 'crazy' and that the delirium is illness or treatment related. A relative or familiar person should be present to interpret the environment and events. Restraints should be used for protection as needed, with all precautions for patient safety.

Medications useful for control of delirium are the antipsychotics with lorazepam added to control agitation and restlessness. (30) T.a.b.le.,1.,3 gives the medications commonly used for control of delirium. Haloperidol remains the most useful because of its multiple routes of administration. However, newer antipsychotics are proving useful, particularly risperidone and olanzepine. Lorazepam is a helpful adjunct for agitation, along with haloperidol (27> (see Chapter,4:.1..12).

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Table 13 Medications used in treatment of delirium

Table 13 Medications used in treatment of delirium

A large study recently explored the risk of factors for delirium, which are applicable in the older patients who are most vulnerable to develop delirium. Preventive interventions to consider are orientation and reorientation to persons and environment, using cognitively stimulating activities, non-pharmacological intervention for sleep improvement (e.g. milk or back rub at bedtime), sleep-enhancement strategies (e.g. noise reduction), ambulation exercises, visual aids, hearing aids, and early recognition of dehydration. (3!>

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