Uncommon Underlying Etiologies of Reversible Delirium in Terminally Ill Cancer Patients

Abstract

complications in fragile patients. 1 We treated four males and four females with a median age of 72 years (range 40e89) and a median Karnofsky performance status of 30% (range 30%e40%). The primary tumor was gastrointestinal cancer in four, lung cancer in two, and other in two. Six patients were receiving opioids. The median neostigmine dose was 0.5 mg (range 0.25e1.25). Two patients received single doses, and six had repeated doses administered every 8e12 hours. Four of eight patients (50%) had evacuation of stools from a few minutes to 10 hours after the injection of neostigmine. No drug-related secondary effects appeared.These results suggest that subcutaneous lowdose neostigmine represents a parenteral alternative approach that can easily palliate severe and refractory constipation in a percentage of cancer patients. Future studies are warranted in order to confirm these data and to test different doses and schedules.