| Confusion |
We have all experienced confusion at one time or another. Usually it is momentary such waking up after a cat nap. In some patients with cancer confusion can be a distressing problem for the patients themselves and their carers. Wherever possible, the underlying cause of the patent's confusion should be investigated and treated as appropriate. This information sheet summaries the causes of confusion and possible ways to alleviate it.
Causes of confusion:
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Salts & chemicals - eg. Dehydration / High calcium - See - "Bone hardening drugs" / High or low sodium / High or low glucose
Drugs - eg Morphine & other opiods / codeine / cimetidine / steroids / benzodiazepines / digoxin
Infection - eg chest, bladder or more seriously meningitis
Management of Confusion and Delirium
·Treat underlying cause where possible
·Explanation to patient and relatives can considerably relieve distress; the presence of a family member at the bedside may have significant calming effect
Drug treatment
Agitation:
diazepam 2-10 mg, max. tds
lorazepam 1-2 mg sublingually/pomidazolam 5 - 10 mg stat subcutaneously10 - 40 mg/12 hourly by sc.infusion
Insomnia: temazepam 10 - 20 mg nocte chlormethiazole 2- 4 tabs nocte
Paranoia: haloperidol
Hallucinations; chlorpromazine 10 - 25 mg tds polim methotrimeprazine 25 - 200 mg 12 hourly by Sc. infusion/po
Alcohol withdrawal: chlormethiazole 10 -25 mg im
Rapid sedation: methotrimeprazine 12.5 -25 mg stst sc./pc midazolam 5 - 20 mg im chlorpromazine 10 - 25 mg im
Nebuilsed dose: 250 - 500 mgs qds
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.