Terminal Delirium — SCE Medical Oncology MCQ

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EasySupportive & Palliative OncologyTerminal DeliriumSCE Medical Oncology

A 72-year-old man with advanced cancer develops agitated delirium in the last days of life. He is pulling at his catheter and climbing out of bed. What is the most appropriate first-line pharmacological management?

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Correct answer: C — Haloperidol 0.5-1.5 mg SC (or levomepromazine 6.25-25 mg SC) — antipsychotics are first-line for terminal delirium/agitation

Terminal delirium/agitation is common in the last days of life (affecting ~40-90% of dying patients). First-line pharmacological management is haloperidol (0.5-1.5 mg SC, repeat 2-hourly as needed) or levomepromazine (6.25-25 mg SC). Midazolam (2.5-5 mg SC) can be added for refractory agitation. Benzodiazepines alone can worsen delirium (paradoxical agitation). Reversible causes should be considered (urinary retention, constipation, medication toxicity, pain) but extensive investigation is inappropriate in the dying phase.

Reference: NICE NG31 Care of dying adults; ESMO Palliative Care; Palliative Care Formulary