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Delirium or acute confusion state is a condition characterised by altered level of consciousness, disorientation to time, place and sometimes to person. There may be fluctuating mental status. The patient may also present with behaviour and psychotic symptoms including agitation, hallucinations and paranoia. It is generally caused by organic brain disease including some medical emergencies. Avoid misdiagnosing delirium as an acute psychotic episode.

Risk Factors

Signs and symptoms

Diagnostic criteria

• Altered level of consciousness
• Disorientation
• Agitation
• Hallucinations
• Paranoia



  • Non-pharmacological

    • Control the acute disturbance.
    • Perform proper physical assessment as well as investigations in order to rule out or ascertain the underlying medical condition and treat accordingly
  • Pharmacological

    Treat the underlying medical condition, if present.

    Acute management

    Haloperidol IM 5 mg.

    • This can be repeated in 60 minutes, if required
    • Maximum dose: 10 mg within 24 hours
    • Monitor vital signs and beware of acute dystonia and neuroleptic malignant syndrome
    • Dosing may vary according to clinical circumstances,

    • Diazepam IV 10 mg.
    • Lorazepam IM 1–4 mg.

    Switch to oral route once containment is achieved.


    • Benzodiazepines, especially diazepam IV, can cause respiratory depression. Monitor patients closely
    • In the frail and elderly patient or where respiratory depression is a concern, reduce the dose by half.
    • The safest route of administration is oral followed by IM with the IV route having the highest risk of respiratory depression and arrest. Use the safest route wherever possible.
    • Monitor vital signs closely during and after administration.
    • Use haloperidol instead of benzodiazepines in patients with respiratory insufficiency.
    • To avoid benzodiazepines toxicity , allow at least 15-30 minutes before repeating the IM dose


Updated on,

20 Novemba 2020 07:36:42


    1. STG
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