Management of Delirium (acute organic brain syndrome)
Treatment principles
• Acute delirium is a medical emergency.
• Establish normal hydration, electrolyte balance and nutrition.
Medication Medication may not be needed but will be in the presence of
anxiety, aggression or psychotic symptoms. (Doses for a fi t adult.)
For anxiety and agitation:
• diazepam 5–10 mg (o) as single dose, can repeat in 1 hr or
• midazolam 1.25–5 mg IM
For psychotic behaviour, add:
• haloperidol 1.5–10 mg (o) according to response or
• olanzapine 2.5–10 mg (o) daily in 1 or 2 doses.
For severe symptoms, when parenteral medication required:
• haloperidol 5–10 mg (IM) as single dose or
• droperidol 5–10 mg (IM) as single dose (more sedating)
For anticholinergic delirium:
• tacrine hydrochloride 15–30 mg with caution by slow IV injection (an
antidote)
Treatment principles
• Acute delirium is a medical emergency.
• Establish normal hydration, electrolyte balance and nutrition.
Medication Medication may not be needed but will be in the presence of
anxiety, aggression or psychotic symptoms. (Doses for a fi t adult.)
For anxiety and agitation:
• diazepam 5–10 mg (o) as single dose, can repeat in 1 hr or
• midazolam 1.25–5 mg IM
For psychotic behaviour, add:
• haloperidol 1.5–10 mg (o) according to response or
• olanzapine 2.5–10 mg (o) daily in 1 or 2 doses.
For severe symptoms, when parenteral medication required:
• haloperidol 5–10 mg (IM) as single dose or
• droperidol 5–10 mg (IM) as single dose (more sedating)
For anticholinergic delirium:
• tacrine hydrochloride 15–30 mg with caution by slow IV injection (an
antidote)