- Is this new? What is she like normally?
- Obs, glucose, NEWS2?
- Any new drugs, opioids, sedatives, or missed alcohol?
- Any falls or head injury? Bowels and urine output?
- Is she safe right now?
Do now
- Glucose, obs, A–E
- 4AT to screen for delirium
- Look for the cause: infection, drugs, retention, constipation, pain, hypoxia, electrolytes
- Bloods incl. Na and Ca; urine; consider CXR
- Non-drug measures first: lighting, family, glasses, hearing aids
Key doses
- Hypoglycaemia: treat now (see low glucose)
- Alcohol withdrawal: Pabrinex IV + CIWA-guided chlordiazepoxide
- Avoid sedation unless a risk to self/others — senior advice, lowest dose
Typical adult doses — always check the BNF and your local guideline.
Call your senior if
- Reduced GCS or new focal signs
- Head injury, especially on anticoagulants
- Septic or hypoxic
- Needs sedation
Think of
- Delirium (infection, drugs, retention, constipation)
- Hypoglycaemia
- Hypoxia
- Hyponatraemia / hypercalcaemia
- Alcohol withdrawal
- Intracranial bleed
Go deeper
The full walkthroughs behind this call.