Delirium Flashcards

1
Q

Delirium - what is it?

A

Global impaired cognition and impaired awareness/ consciousness.

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2
Q

Delirium - How common?

A

Very common. It affects 30% of elderly patients in medical and surgical wards. It is associated with high rate of mortality, complications, institutionalisation and longer lengths of stay.

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3
Q

Signs of delirium

A

o Disordered thinking
o Euphoria: fearful, depressed or angry-mood changes
o Language impaired: reduced speech, change in behaviour
o Illusion /hallucination (visual): delusion-disturbed perception
o Reversal of the sleep
o In attention
o Unaware/disorientated: mainly to time
o Memory deficit-impaired

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4
Q

Delirium - Causes

A

o Drugs: opiates, anticonvulsants, L-dopa
o Alcohol withdrawal
o Metabolic: hypoglycaemia, uraemia, liver failure, U&E imbalance, anaemia
o Hypoxia: respiratory and heart failure, pulmonary oedema
o Vascular: MI, stroke
o Infections & intracranial tumours: meningitis, encephalitis, pneumonia, cellulitis, abscess
o Head injury: subdural haematoma
o Epilepsy
o Nutritional: B1, B12 and nicotinic acid deficiencies

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5
Q

Delirium - Diagnostic criteria

A

o Disturbed consciousness.
o A change in cognition (ex: memory, language, orientation or development of perceptual disturbances).
o Development of the disturbances over a short period (hours and days)
o Evidence from history, physical examination or lab. findings, that the disturbances are caused by direst consequences of: Medical condition & Substance intoxication or withdrawal

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6
Q

Delirium - Ix

A

Infection:

  • Full blood count
  • Chest x-ray
  • Urinalysis
  • B&U culture
  • Wound swab

Metabolic disturbances:

  • U&E
  • Blood glucose
  • Liver function test
  • Thyroid function
  • B12 & folate levels

Toxic effect:
- Digoxin and other drugs estimation

Acute neurological conditions:

  • CT scan only when intracranial lesion is suspected (focal neurological sign, recent head injury) or no other physical case for delirium is identified
  • Lumbar puncture, only if meningitis or encephalitis are suspected

Hypoxia:

  • Arterial blood gases
  • Chest x-ray
  • ECG
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