ACUTE CONFUSIONAL STATE Flashcards
What are the causes of delirium?
P - Pain
I - Infection
N - Nutrition
C - Constipation
H - Hydration
E - Endocrine + Electrolyte
S - Stroke
M - medication and Alcohol
E - Environmental
What is the preferred test for asessing for delirium? What does it consist of?
4AT
- AMT4
- Attention
- Alertness
- Acute change?
What is the first and second line medical management of delirium?
- Haloperidol
- Lorazepam
- Both can be given PO or IM
What si the max rate of sodium replenishment in a patient with acute or chronic hyponatraemia?
In a patient with acute hyponatremia, what shoudl be the max rise i thr first hour and first 24 hours?
-
Acute
- 4-6mmol/L over 4 hours
-
Chronic
- low risk of ODS 4-8mmol/L/D
- High risk of ODS 4-6mmol/L/D
- Acute changes
- never allow sodium to rise by >5mmol in first hour
- Never allow sodium to rise by >10mmol in first 24 hours
What is the major risk associated with rapid reversal of hyponatremia?
- Pontime myelinosis
What si the most common cause of both hyponatremia in general and normovolemic hyponatremia?
- SIADH
Name a rare but important cause of hypernatremia
Diabetes insipidus
Calcium over 3 is almost always what?
Malignancy
Why is ECG important in all patients with hypercalcemia?
They may develop short QT interval
What is the management of treatment responsive hypercalcemia?
- rehydration with 6L 0.9% NaCl over 24 hours
- IV bisphosphonate
What are the two management options for patients with treatment resistant hypercalcemia?
- IM calcitonin
- PO steroids
Give two eponymous signs associated with hypocalcemia?
- Chvostek’s sign- tap facial nerve in the corner of the ear and see spasm at the side of the mouth
- Trousseau’s sign- Inflate sphygmomanometer and trigger carpopedal spasm
How do you treat acute hypocalcemia?
- Give 10ml calcium gluconate 10% solution in 100mls sodium chloride 0.9% over 10 minutes
- When sorted push on to oral calcium and vitamin D
What is the definitive cut off for treatment of hyperkalaemia?
K+ > 6.5
Name 4 cardinal signs of hyperkalaemia on ECG
- Tall tented t waves
- Widened QRS
- Flattened p waves
- prolonged PR interval