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Agitated delirium — DGM MCQ

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HardDeliriumAgitated deliriumDGM

An 86-year-old man with dementia is admitted with cellulitis and becomes severely agitated, trying to pull out his cannula. He is in pain, has urinary retention on bladder scan and his family cannot settle him. De-escalation and treating pain have been attempted. What is the most appropriate management?

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Correct answer: A — Treat retention and pain, then consider short-term low-dose haloperidol if risk persists

The priority is to treat reversible causes and use non-pharmacological strategies; short-term low-dose antipsychotic can be considered when distress or risk remains. Diazepam can worsen delirium and falls except in specific indications such as alcohol withdrawal. A key pearl is to avoid chemical restraint while also recognising when brief pharmacological treatment protects the patient.

Reference: NICE CG103