A 77-year-old man with metastatic prostate cancer and an estimated glomerular filtration rate of 18 mL/min/1.73 m² has been receiving regular oral morphine. Over 2 days he has developed increasing drowsiness, vivid dreams and intermittent multifocal myoclonus, without severe pain at rest. His family asks for a larger morphine dose because he sometimes reports pain when repositioned. Which management is most appropriate?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from Geriatrics and Palliative Care
See allA 78-year-old woman becomes agitated and repeatedly pulls at her intravenous line on the second night after hip surgery. She alternates between asking where she…
Clinical rotations · common
An 82-year-old woman has fallen twice since her medicines were changed. She is slower when walking and has recently complained of constipation, blurred vision a…
Pre-internship · common
A 74-year-old man is referred after three falls over two months. He describes a brief feeling of faintness after rising from a chair, without spinning sensation…
Clinical rotations · common
A 79-year-old man has fallen three times in two months, usually when walking to the toilet at night. He has slowed reactions and feels unsteady for several hour…
Pre-internship · common
An 82-year-old woman becomes confused and unsteady over three days while being treated for depression and hypertension. She is euvolaemic, her serum sodium is 1…
Clinical rotations · common