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Constipation delirium — DGM MCQ

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ModerateDeliriumConstipation deliriumDGM

An 89-year-old woman with advanced osteoarthritis becomes acutely confused after starting codeine. She has abdominal discomfort and has not opened her bowels for five days. Observations are normal and urine dipstick is negative. Current medicines include codeine, amlodipine and calcium carbonate. What is the most appropriate management?

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Correct answer: E — Treat constipation and review codeine

Constipation from opioid treatment is a reversible delirium precipitant, so bowel treatment and opioid review are appropriate. Antibiotics without urinary symptoms promote harm, increasing codeine worsens constipation, colonoscopy is not the immediate need, and antipsychotics do not address the cause. Pain medicines and bowels should be reviewed together in delirium.

Reference: NICE CG103; NICE CKS constipation