Common Symptoms at End of Life and Their Treatment
| Symptom | Management |
| PO = by mouth; prn = as needed; IV = intravenous; SQ = subcutaneous; SL = sublingual. | |
| Myoclonus | Consider etiology (usually high-dose opioids administered over a prolonged period). |
| Hydrate. | |
| Rotate to alternate opioid. | |
| Use benzodiazepines; if patient cannot swallow, use midazolam or lorazepam. | |
| Dyspnea | Use opioids (small, frequent doses as needed for opioid-naïve patients [e.g., 2.5 mg morphine PO every hour prn]; opioid-tolerant patients will require dose adjustment and upward titration). |
| Use benzodiazepines only if anxiety is present. | |
| Use glucocorticoids or bronchodilators for bronchospasm. | |
| Use antibiotics if cause is infectious and this is consistent with goals of care. | |
| Use oxygen only when hypoxia is present. | |
| Direct a cool fan toward the face. | |
| Reposition (elevate head of bed; if patient has nonfunctioning lung, position on side with that lung down). | |
| Use cognitive-behavioral therapies such as guided imagery. | |
| Use integrative therapy such as acupuncture. | |
| Fatigue | Use methylphenidate (Ritalin) 2.5 mg twice daily (in a.m. and at noon) to start; increase up to 30 mg/day; anxiety and restlessness may occur. |
| Use d-amphetamine (Dexedrine) 2.5 mg/day to start; increase up to 30 mg/day; anxiety and restlessness may occur. | |
| Use modafinil (Provigil) 50–100 mg/day to start; increase to 100–200 mg/day. | |
| Suggest energy conservation methods. | |
| Employ sleep hygiene measures. | |
| (Refer to the PDQ summary on Fatigue for more information.) | |
| Cough | Consider etiology (infection, bronchospasm, effusions, lymphangitis, cardiac failure) and treat accordingly. |
| Use opioids (small, frequent doses to start for opioid-naïve patients; opioid-tolerant patients will require dose adjustment and upward titration). | |
| Use other antitussives such as guaifenesin or dextromethorphan. | |
| Use glucocorticoids such as dexamethasone to manage cough due to bronchitis, asthma, radiation pneumonitis, and lymphangitis. | |
| Use bronchodilators such as albuterol 2–3 inhalations every 4–5 hours for bronchospasm leading to cough. | |
| Use nonsedating antihistamines with or without decongestants for sinus disease. (Suggest nonsedating agents if fatigue or sedation is a problem.) | |
| Use diuretics to relieve cough due to cardiac failure. | |
| (Refer to the PDQ summary on Cardiopulmonary Syndromes for more information.) | |
| Rattle | Use scopolamine transdermal patch, 1.5 mg (start with one or two patches; if ineffective, switch to 50 µg/hour continuous IV or SQ infusion and double the dose every hour, up to 200 µg/hour). |
| Use glycopyrrolate, 1–2 mg PO; or 0.1–0.2 mg IV or SQ every 4 hours; or 0.4–1.2 mg/day continuous infusion. | |
| Use atropine, 0.4 mg SQ every 15 minutes prn. | |
| Use hyoscyamine, 0.125–0.25 mg PO or SL every 4 hours. | |
| Change position or elevate head of bed. | |
| Reduce or discontinue enteral or parenteral fluids. | |
| Avoid suctioning. | |
| Delirium | Stop unnecessary medications. |
| Hydrate. | |
| Use haloperidol, 1–4 mg PO, IV, or SQ every 1–6 hours prn. | |
| Use olanzapine, 2.5–20 mg PO at bedtime. | |
| (Refer to the PDQ summary on Cognitive Disorders and Delirium for more information.) | |
| Fever | Use antimicrobials if consistent with goals of care. |
| Use antipyretics such as acetaminophen. | |
| Apply cool cotton cloths. | |
| Give tepid sponge baths. | |
| Hemorrhage | Use vitamin K or blood products for chronic bleeding if consistent with goals of care. |
| Use aminocaproic acid (PO or IV). | |
| Induce rapid sedation with IV midazolam when catastrophic hemorrhage occurs. | |
| Use blue or green towels to minimize distress. | |
