skip to main content

Agitated delirium with QT prolongation and parkinsonism — SCE Geriatric Medicine MCQ

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

HardDeliriumAgitated delirium with QT prolongation and parkinsonismSCE Geriatric Medicine

An 90-year-old man with dementia is admitted with agitation. He is shouting that staff are stealing his clothes, but he is easily reassured by his daughter. He has urinary retention of 700 mL, constipation and pain from a pressure ulcer. QTc is 510 ms and he has Parkinsonism. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: E — Treat reversible causes and avoid antipsychotics unless risk remains severe after non-drug measures

The agitation is occurring with multiple delirium precipitants: retention, constipation, pain and environmental distress. A prolonged QTc and parkinsonism make antipsychotic harm more likely, so treating causes and using family-supported de-escalation are key. Haloperidol may be unsafe here unless benefits clearly outweigh risks in an emergency. The pearl is to look for pain and urinary retention before prescribing sedation for agitation.

Reference: NICE CG103; NICE NG97; BNF