Steroid-Induced Delirium

Mechanism and Evidence

The National Comprehensive Cancer Network identifies corticosteroids as risk factors for delirium in cancer patients and critically ill populations 1, 2
The American College of Physicians and other guideline societies recommend reducing or eliminating delirium-inducing medications, including steroids, when possible 1, 3

High-dose steroids significantly increase the risk of delirium, according to the European Society of Intensive Care Medicine 4
Patients with advanced age are at higher risk of delirium, as stated by the National Comprehensive Cancer Network 3
Pre-existing cognitive impairment increases the risk of delirium, as noted by the National Comprehensive Cancer Network 1
Cancer patients, particularly those with haematological malignancies, bone metastases, or hypoalbuminaemia, are at higher risk of delirium, according to the European Society for Medical Oncology 2, 5

Mixed delirium, characterized by fluctuating features of hypoactive and hyperactive delirium, can occur in patients taking steroids, as described by the European Society for Medical Oncology 5
Cognitive disturbances, such as impaired attention and disorientation, are common symptoms of steroid-induced delirium, according to the National Comprehensive Cancer Network 1
Sleep-wake cycle disturbances are also a symptom of steroid-induced delirium, as noted by the European Society for Medical Oncology 5

The National Comprehensive Cancer Network recommends avoiding high-dose steroids when possible to prevent delirium 4
If delirium occurs, the National Comprehensive Cancer Network suggests reducing or eliminating steroids if clinically feasible, and implementing non-pharmacologic interventions first 1, 3
For moderate delirium, the National Comprehensive Cancer Network recommends considering oral haloperidol, risperidone, olanzapine, or quetiapine 1, 3
For severe delirium with agitation, the National Comprehensive Cancer Network suggests considering antipsychotic medications such as haloperidol, olanzapine, or chlorpromazine 1, 3

Untreated steroid-induced delirium can lead to weight loss and malnutrition, as noted by the National Comprehensive Cancer Network 1

The National Comprehensive Cancer Network warns against overlooking hypoactive delirium, which is often underdiagnosed but is the most prevalent subtype in palliative care patients 1, 3
The National Comprehensive Cancer Network advises against using benzodiazepines as initial treatment for steroid-induced delirium unless the patient is already taking them 1, 3
The European Society for Medical Oncology notes that multiple medications can contribute to delirium simultaneously, particularly opioids, benzodiazepines, and corticosteroids 2

Proporcionar iluminación adecuada, señalización clara, relojes visibles y calendarios para ayudar en la orientación, según la Sociedad Americana de Medicina Interna 6
Facilitar visitas regulares de familiares y amigos para ayudar con la reorientación del paciente, según la Sociedad Americana de Medicina Interna 6
Asegurar una hidratación adecuada y prevenir el estreñimiento, según la Sociedad Americana de Medicina Interna 6
Considerar la hidratación adecuada y la movilización temprana como medidas preventivas, según la Sociedad Americana de Medicina Interna 6

Considerar ajustar la dosis o cambiar a un régimen alternativo si los efectos secundarios son inmanejables, según la Sociedad de Neurología de Lancet 7
En casos donde los glucocorticoides son esenciales para el tratamiento, considerar una reducción de aproximadamente 25-33% de la dosis, según la Sociedad de Neurología de Lancet 7
En casos de agitación severa que representa un riesgo para el paciente o para otros, considerar el uso de antipsicóticos como olanzapina, según la Sociedad de Oncología de Annals 8
La dexmedetomidina puede ser útil en casos de delirio agitado, especialmente en pacientes no intubados, según la Sociedad de Medicina Intensiva 9

Reevaluar la necesidad de medicación antipsicótica regularmente, según la Sociedad de Oncología de Annals 8