Checklist for Treatment of Delirium in the ICU
Remove causative factors
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Exclude hypoglycemia if this is possible
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Review the medication list and d/c deliriogenic meds if possible.
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Treat hypernatremia if present.
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Remove unnecessary invasive devices/tubes & restraints.
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Consider scheduled acetaminophen if uncontrolled pain or persistent fevers.
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If Wernicke's encephalopathy possible, empiric thiamine 500 mg IV Q8hr
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If cirrhotic, consider empiric treatment for hepatic encephalopathy
Sleep maintenance
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Scheduled melatonin agonist before sleep (melatonin -•3 mg or ramelteon 8 mg).
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Earplugs & eye shades at night if tolerated.
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Avoid unnecessary sleep interruption (e.g. frequent Bp cuff monitoring).
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If difficulty sleeping, administer pharmacologic therapy early in the night (e.g. quetiapine 50 mg qhs)
Nocturnal dexmedetomidine
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May be useful in patients with severe nocturnal agitation, especially if this is refractory to antipsychotic therapy.
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Use dexmedetomidine at night, titrate to light sleep.
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Discontinue dexmedetomidine during the day to maintain circadian rhythm.
Reorientation during the day
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Use patient's glasses & hearing aides if needed
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Physical therapy and early mobilization.
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