Delirium — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGeriatric MedicineDeliriumRACP Adult Medicine

A 78-year-old woman is admitted with delirium. She is agitated, pulling at her lines, and attempting to leave the ward. Non-pharmacological interventions have been exhausted. Her ECG shows a QTc of 440 ms. What is the most appropriate pharmacological agent for acute management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Haloperidol 0.5–1 mg IM/IV

For hyperactive delirium requiring pharmacological intervention after non-pharmacological measures have failed, low-dose haloperidol (0.5–1 mg IM/IV, repeated after 30–60 minutes if needed) remains first-line. The QTc should be monitored as haloperidol can prolong it. Benzodiazepines worsen delirium (except in alcohol/benzodiazepine withdrawal or seizures). Doses should be minimised and treatment limited to the shortest duration possible. Antipsychotics do not treat the underlying cause.

Reference: eTG – 2025 – Psychotropic; ACSQHC – 2021 – Delirium Clinical Care Standard