Delirium Flashcards
Delirium - what is it?
Global impaired cognition and impaired awareness/ consciousness.
Delirium - How common?
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.
Signs of delirium
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
Delirium - Causes
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
Delirium - Diagnostic criteria
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
Delirium - Ix
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