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Less Is More
Aug 13/27, 2012

Pain as a Cause of Agitated Delirium

Author Affiliations

Author Affiliation: Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, New York.

Arch Intern Med. 2012;172(15):1130. doi:10.1001/archinternmed.2012.2088

An 85-year-old woman with multiple medical problems, including dementia, coronary artery disease, renal insufficiency, and peripheral vascular disease, was admitted to our hospital with urosepsis. Her hospital course was complicated by the development of dry gangrene of her left foot, Candida sepsis, Clostridium difficile enterocolitis, and multiple deep sacral and trochanteric pressure ulcers. When housestaff asked her son if he wanted us “to do everything,” he always answered yes. She was able to be weaned from the ventilator and was transferred to a medical unit for continued treatment of hospital-acquired C difficile enterocolitis and wound care of her multiple stage 4 ulcers. She underwent 4 surgical debridements under general anesthesia in the operating room over a several-month period but remained persistently febrile despite continuous treatment with broad spectrum antibiotics.