Management of Hyperactive Delirium
 • Behavioral management ...
287
Description

Management of Hyperactive Delirium

 • Behavioral management 

 • Identify & treat UNDERLYING CAUSE w/ special attention to life-threatening conditions (see Altered Mental Status)

 • Daily EKG to monitor QTc (<550msec); Daily repletion of K>4 & Mg>2 (in anticipation of pharmacotherapies)

Medication Management (for dangerous behavior ONLY)

For HYPERactive delirium/AGITATION → start PRN, escalate to scheduled 

 • Haloperidol 2-5mg IV q3h PRN vs. 0.5-1mg PO q4h PRN vs. IM q1h PRN (can lead to EPS, acute dystonias in

Parkinsonism)

 • Quetiapine 12.5-50 mg PO q6-12h PRN

 • Olanzapine 2.5-10 mg SL/PO/IM qd-q4h PRN

*QTc prolong severity: Haloperidol > Quetiapine > Olanzapine; ∆ tx if QTc ↑ by 25-50%, QTc>500, +U-wave/T-wave flattening

If continued severe agitation  consider Psych/Geri consult:

 • Haloperidol PRN: double PRN dose q20 min till effective, ~5-20 mg IV, consider standing or gtt (ICU);

 • Quetiapine PRN, standing 25-50 mg TID, extra dose HS.

 • Olanzapine PRN: standing 2.5-10 mg BID, extra dose HS

Discontinue when able, avoid benzos. Prolonged antipsychotic use in elderly can increase mortality.



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