doi: 10.56294/shp2024135

Short communication

Pharmacological management of acute confusional state in Latin America

Manejo farmacológico del Síndrome Confusional Agudo en América Latina

Valeria Paola Laguna Ramos¹ *, Marcelo Adrián Estrin¹ *

¹Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Carrera de Medicina. Buenos Aires, Argentina.

Cite as: Laguna Ramos VP, Estrin MA. Pharmacological management of acute confusional state in Latin America. South Health and Policy. 2024; 3:135. https://doi.org/10.56294/shp2024135

Submitted: 29-07-2023                   Revised: 09-10-2023                   Accepted: 27-03-2024                 Published: 28-03-2024

Editor: Dr. Telmo Raúl Aveiro-Róbalo

Corresponding author: Valeria Paola Laguna Ramos *

ABSTRACT

Acute confusional syndrome (ACS) was described as an acute and fluctuating mental disorder, common in older adults hospitalised in Latin America. The pharmacological use of haloperidol and benzodiazepines in its treatment was analysed. Haloperidol was widely used due to its efficacy and low cost, although warnings were given about its adverse effects, such as extrapyramidal symptoms and arrhythmias. Benzodiazepines were reserved for cases of alcohol withdrawal due to their cognitive and respiratory risks. The importance of monitoring, prevention and staff training protocols was emphasised in order to improve the management of ACS in the region.

Keywords: Haloperidol; Benzodiazepines; Delirium; Hospitalisation; Monitoring.

RESUMEN

El Síndrome Confusional Agudo (SCA) fue descrito como una alteración mental aguda y fluctuante, frecuente en adultos mayores hospitalizados en América Latina. Se analizó el uso farmacológico de haloperidol y benzodiacepinas en su tratamiento. El haloperidol se utilizó ampliamente por su eficacia y bajo costo, aunque se advirtió sobre sus efectos adversos, como los síntomas extrapiramidales y arritmias. Las benzodiacepinas se reservaron para casos de abstinencia alcohólica debido a sus riesgos cognitivos y respiratorios. Se destacó la importancia de protocolos de monitoreo, prevención y formación del personal para mejorar el manejo del SCA en la región.

Palabras clave: Haloperidol; Benzodiacepinas; Delirium; Hospitalización; Monitoreo.

BACKGROUND

Acute Confusional Syndrome (ACS), also known as delirium,^(1,2,3) is a clinical condition characterized by an acute and fluctuating alteration of mental status, primarily affecting hospitalized older adults.^(4,5,6,7) Its pharmacological management has been studied in Latin America, especially using haloperidol and benzodiazepines.^(8,9,10)

Haloperidol, a typical antipsychotic,⁽¹¹⁾ has been widely used in the treatment of ACS due to its efficacy in controlling symptoms such as agitation and hallucinations.^(12,13) Its pharmacological profile and low anticholinergic effects make it suitable for older patients.⁽¹⁴⁾ However, its use requires caution, as high doses may be associated with adverse effects such as extrapyramidal symptoms and QT interval prolongation, which can lead to cardiac arrhythmias.⁽¹⁵⁾ Therefore, starting with low doses and monitoring the patient closely is recommended.

Benzodiazepines, such as lorazepam, have been used in the management of ACS, especially in cases related to alcohol withdrawal.⁽¹⁶⁾ However, their use in other contexts is controversial due to risks such as excessive sedation, respiratory depression, and worsening cognitive function.^(17,18) Current clinical guidelines advise against their routine use in the treatment of ACS, except in specific situations such as alcohol withdrawal or when antipsychotics are contraindicated.^(19,20,21)

In Latin America, the prevalence of ACS in hospitalized patients is significant, and its management presents particular challenges.^(22,23) Factors such as drug availability, limited resources, and the need for specific training for healthcare personnel influence treatment strategies. Haloperidol remains the drug of choice in many centers due to its efficacy and relatively low cost.^{(26,27,28,29)} However, it is essential to implement monitoring protocols to minimize risks and tailor interventions to local needs and resources.

The management of ACS in Latin America requires a balanced approach that considers pharmacological treatments’ efficacy and potential risks. Haloperidol, administered with caution, remains a valuable tool in treating ACS. Benzodiazepines should be reserved for specific cases and used with extreme caution. Strengthening prevention, early diagnosis, and healthcare worker training strategies is essential to improving outcomes for patients with ACS in the region.

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FUNDING

None.

CONFLICT OF INTEREST

None.

AUTHOR CONTRIBUTION

Conceptualization: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Data curation: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Formal analysis: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Research: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Methodology: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Project management: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Resources: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Software: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Supervision: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Validation: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Visualization: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Writing – original draft: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.

Writing – review and editing: Valeria Paola Laguna Ramos, Marcelo Adrián Estrin.