An 89-year-old woman is admitted with severe back pain, reduced mobility and confusion after starting tramadol for vertebral fracture pain. Sodium is

Question

An 89-year-old woman is admitted with severe back pain, reduced mobility and confusion after starting tramadol for vertebral fracture pain. Sodium is 128 mmol/L, creatinine is baseline, 4AT is 5 and she has not opened bowels for six days. What is the most appropriate management?

Accepted Answer

Stop tramadol, treat constipation and delirium precipitants, and use a safer multimodal analgesic plan

Answer

Increase tramadol because uncontrolled pain causes delirium

Answer

Add diazepam to reduce muscle spasm and agitation

Answer

Use long-term bed rest to reduce vertebral pain

Answer

Ignore constipation until delirium has resolved

Tramadol-associated delirium and constipation — SCE Geriatric Medicine MCQ

An 89-year-old woman is admitted with severe back pain, reduced mobility and confusion after starting tramadol for vertebral fracture pain. Sodium is 128 mmol/L, creatinine is baseline, 4AT is 5 and she has not opened bowels for six days. What is the most appropriate management?