Excited delirium: Difference between revisions
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***1-2mg/kg IV | ***1-2mg/kg IV | ||
**Case reports using dantrolene<ref>Allam, S: Cocaine-excited delirium and severe acidosis. Anaesthesia. 2001 Apr; 56(4):385-6</ref> | **Case reports using dantrolene<ref>Allam, S: Cocaine-excited delirium and severe acidosis. Anaesthesia. 2001 Apr; 56(4):385-6</ref> | ||
**Consider IV olanzapine 2.5-5 mg IV q5-10min to max dose of 20mg | **Consider IV olanzapine 2.5-5 mg IV q5-10min to max dose of 20mg | ||
***In place of IV haloperidol, which is approximately half as potent (~5-10 mg haloperidol = ~2.5-5 mg olanzapine) | ***In place of IV haloperidol, which is approximately half as potent (~5-10 mg haloperidol = ~2.5-5 mg olanzapine) | ||
***May be safer in pts with prolonged QTc or those too agitated to obtain ECG | ***May be safer in pts with prolonged QTc or those too agitated to obtain ECG | ||
Revision as of 15:28, 18 May 2016
Background
- Also known as agitated delirium
- Controversial diagnosis, not recognized by DSM 4 or ICD 9
- Recognized by ACEP in 2009[1]
- Agitation, aggression, acute distress, often in pre-hospital setting including police custody[2]
- Associate with hyperthermia, drug use and sometimes death[2]
Clinical Features[1]
- Triad of delirium, psychomotor agitation and physiological excitation
- Associated with drug use: cocaine (#1), methamphetamine, alcohol, PCP, LSD
- Associated with mental health disease
- Typically male, mean age 30's
- Violent, combative, belligerent, bizarre behavior
- Resistant to physical restraint, superhuman strength
- Associated with cardiopulmonary arrest
Differential Diagnosis
Diagnosis
- Typical clinical features associated with
- Tachycardia
- Tachypnea
- Hyperthermia
- Acidosis
- Rhabdomyolysis
Management
- Supportive care: reversal of clinical and lab abnormalities
- Hyperthermia: Remove clothing, misting/airflow, ice packs , cold IV fluids
- Acidosis: IV fluids; bicarb controversial
- Rhabdomyolysis: IV fluids
- Hyperkalemia
- Agitation: Physical and Chemical sedation
- Benzodiazipines, Neuroleptics
- Ketamine use increasingly described [3]
- 4-5mg/kg IM
- 1-2mg/kg IV
- Case reports using dantrolene[4]
- Consider IV olanzapine 2.5-5 mg IV q5-10min to max dose of 20mg
- In place of IV haloperidol, which is approximately half as potent (~5-10 mg haloperidol = ~2.5-5 mg olanzapine)
- May be safer in pts with prolonged QTc or those too agitated to obtain ECG
- IV olanzapine may be as safe or safer than IM, with faster onset
Disposition
- Based on severity of clinical presentation and response to treatment
See Also
External Links
References
- ↑ 1.0 1.1 ACEP White Paper Report on Excited Delirium Syndrome. Sept 10, 2009
- ↑ 2.0 2.1 Takeuchi, A. Excited Delirium. West J Emergency Medicine; 2011 Feb; 12 (1): 77-83
- ↑ Roberts, J: Emergency Medicine News website. http://journals.lww.com/em-news/Fulltext/2015/12000/InFocus__Ketamine_an_Ideal_Treatment_for_Excited.18.aspx Unknown published date. Accessed Dec 13, 2015
- ↑ Allam, S: Cocaine-excited delirium and severe acidosis. Anaesthesia. 2001 Apr; 56(4):385-6