Confusion

This can arise from anxiety, drug induced (especially opioid toxicity), metabolic

disturbances, hypoxia, disorders of the nervous system and distension of the bladder. It can be alarming for the families and carers to witness  and again good communication provide reassurance. For example symptoms may include patients may demand for the police to be called as an unseen being is attacking them, living in the past and unable to recognise the family.

 

Simple actions may be taken to help calm patients such as maintaining a safe and

comfortable environment with familiar faces, holding the patient’s hand and providing

reassurance. Due to the sedative nature of some of the drugs utilised, it is agreeable to

discuss this side effect to the families before proceeding with treatment.

 

 

The following drugs are used:

 

Haloperidol

This is indicated in drug toxicity and metabolic upset. In patients able to swallow,

oral dose of 1.5-3mg is administered and reviewed after one hour. Alternatively a

subcutaneous infusion of 5-30mg over 24 hours is available.

 

 Midazolam

Indicated in patients that are anxious, distressed or at risk of seizure and

subcutaneous infusion of 5-100mg over 24 hours or a bolus of 2.5-10mg is beneficial.

 

 Levomepromazine

This is administered to patients who require further sedation but this drug is to be

used with caution in those susceptible to seizures because the seizure threshold may be lowered by levomepromazine. It is available as a subcutaneous bolus of 25mg

or an infusion of 250mg over 24 hours.