Terminal delirium and terminal restlessness
Delirium and agitation in the last days of life, the reversible causes worth finding, the bladder and drug causes not to miss, non-drug care, haloperidol and midazolam doses, what the Hui trials (2017, 2020, 2025) showed, and proportionate palliative sedation.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Delirium is the commonest neuropsychiatric problem at the end of life: 88% of patients with advanced cancer were delirious before death in Lawlor 2000.
- Terminal delirium is delirium in the last days, often from multiorgan failure and not reversible. Terminal restlessness is agitated behaviour in a dying patient, and has several causes besides delirium.
- Look for the quick fixes first: full bladder, loaded rectum, pain, drug toxicity, withdrawal.
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Sources
- Therapeutic Guidelines: Palliative Care (eTG complete), version 5AU/NZTherapeutic Guidelines Limited, 2024 (version 5, December 2024)
- Delirium Clinical Care Standard (revised 2021)AU/NZAustralian Commission on Safety and Quality in Health Care, 2021 (current at November 2026)
- Surges SM et al. Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: an international Delphi study. Palliat Med 2024;38:213-228European Association for Palliative Care, 2024
- Lawlor PG et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000;160:786-794Archives of Internal Medicine, 2000
- Agar MR et al. Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: a randomized clinical trial. JAMA Intern Med 2017;177:34-42AU/NZJAMA Internal Medicine, 2017
- Hui D et al. Effect of lorazepam with haloperidol vs haloperidol alone on agitated delirium in patients with advanced cancer receiving palliative care: a randomized clinical trial. JAMA 2017;318:1047-1056JAMA, 2017
- Hui D et al. Neuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trial. Lancet Oncol 2020;21:989-998Lancet Oncology, 2020
- Hui D et al. Proportional sedation for persistent agitated delirium in palliative care: a randomized clinical trial. JAMA Oncol 2025;11:1031-1043JAMA Oncology, 2025
- Maltoni M et al. Palliative sedation in end-of-life care and survival: a systematic review. J Clin Oncol 2012;30:1378-1383Journal of Clinical Oncology, 2012
- Schedule of Pharmaceutical Benefits: Palliative Care (haloperidol and clonazepam injection, clonazepam oral liquid)AU/NZPharmaceutical Benefits Scheme, Australian Government, September 2026
- Last updated
- 14 November 2026
What changed
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