SAQ 414 – Geriatrics – agitation and delirium
Model Answer
Geriatrics – agitation and delirium.
a. Differential categories
| Category | Examples |
|---|---|
| Infective | UTI; pneumonia; meningitis. |
| Metabolic/endocrine | Hyponatraemia; hypoglycaemia. |
| CNS | Stroke; subdural haemorrhage; intracranial neoplasm or complication. |
| Drug-related | Anticholinergic medicines such as tricyclics or phenothiazines; serotonin syndrome; missed or reduced sedative medicines. |
| Gastrointestinal | Ischaemic gut; bowel obstruction. |
| Cardiovascular | Silent myocardial infarction; arrhythmia such as AF; pulmonary embolus. |
b. Drugs for agitation
| Drug | Dose | Adverse effects |
|---|---|---|
| Midazolam | 1-2 mg IV, titrated carefully to effect in an elderly patient. | Excessive sedation; respiratory depression; falls/paradoxical agitation. |
| Haloperidol | 0.5-1 mg oral/IM/IV, titrated carefully to effect. | Extrapyramidal effects; QT prolongation/arrhythmia; excessive sedation. |
| Olanzapine | 2.5-5 mg oral/IM if an antipsychotic alternative is suitable. | Excessive sedation; hypotension; anticholinergic effects. |
c. Delirium versus dementia
- Delirium has clouding of consciousness; dementia usually has normal conscious level until late.
- Delirium fluctuates in severity; dementia is usually more stable day to day.
- Delirium is usually reversible; dementia usually is not.
- Delirium has acute onset; dementia has gradual onset.
- Delirium may have acutely abnormal vital signs, especially fever; dementia usually has normal vital signs.
Comments are closed for this SAQ.