25.1.16
Drowsiness
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 25, Palliative Care.
Clinical Description
Common causes (see relevant chapter for details)
Commonly drug induced, especially when using high dose of opiates and or in renal failure, hypercalcaemia
Non-pharmacological
- attention to determine cause, prevent aspiration during feeding (NG tube and/or upright positioning)
Pharmacological
- Carefully review drugs being taken by the patient, monitor urine output (if reduced, suggests renal impairment). If opiate toxicity (drowsy, pin point pupils, muscle twitching, reduced respirations) then STOP opiates and monitor carefully before reintroducing. In hypercalcaemia (drowsiness, nausea, constipation, bone pain) use of IV normal saline 2-3 litres/24 hr, bisphosphonates at central hospital (see section under oncology for details)
Complications and Referral Criteria
Refer to the rehabilitation technicians for occupational therapy. This must happen concurrently with all other treatment.
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