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The approach
to management of delirium is complex, as it has multiple etiologies,
often with several co-existing in a single patient. In many cases,
particularly in terminal delirium, the etiology is multi-factorial
and cannot be determined. For example, Bruera
et al., (1992b),
found an underlying cause in less than 50% of terminally ill patients
with cognitive impairment.
To add to
this, some contributing factors may be correctable (e.g.
sepsis, dehydration, opioid toxicity, hypercalcemia) and some
may not (e.g. brain metastases). Correction of underlying contributors
may lead to improvement or reversibility of the symptoms of delirium
and to improvement in the general condition of the patient. A
delirium reversibility rate of 49% has been reported with management
of underlying contributors (Lawlor
et al., 2000a).
Reversibility was significantly higher for first episodes of delirium
as compared to recurrent episodes and opioid and non-opioid medications
were independently associated with reversibility.
In addition
to specific management of underlying causes, it is also necessary
to use general supportive and symptomatic treatment (Bruera
et al., 1992b; Fainsinger
et al., 1991).
Supportive therapy involves adequate hydration, electrolyte balance,
nutrition and measures to help reduce anxiety and disorientation.
Such support measures have not been well studied in terms of their
impact on the symptoms of delirium (Breitbart
et al., 1995).
Appropriate symptomatic treatment depends on the type of delirium
and is considered in choice of drugs below.
Studies focusing
on management of delirium should address the following issues.
Click on any of these issues to learn more.
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