Delirium Flashcards
features of delirium
impaired consciousness
impaired memory, attention, hallucination, delusion, loss of time place and person
hyper/hypoalert or mixed
insomnia, sleep wake reversal or nocturnal symptom worsening
anxiety, agitated, aggressive, apathy, euphoria
can be rapid, transient and flux, days/months
causes of delirium
infection bleed, MI, PE, HF hypoxia liver failure/pancreatitis hypoglycaemia renal failure tumour epilepsy withdrawal
drug causes delirium
anticholergic anticonvulsants antiparkinsonian steroids opiate sedatives alcohol illicit cimetidine
drug withdrawal causes delirium
BZD
alcohol
barbiturates
illicit
infectious causes delirium
UTI
meningitis/encephalitis
pneumonia
vascular causes delirium
TIA/stroke thrombosis embolus MI HF Migraine
metabolic causes delirium
hypoglycaemia hypoxia renal/liver failure hypo/hyperthyroid hypopituitarism porphyria carcinoid syndrome fluid/electrolyte imbalance
risk factors for delirium
age cognitive deficit previous hx perioperative hypo/hyperthermia deaf/blind immobile social isolation new environment stress
investigating delirium
Hx and exam full cognitive assessment urinalysis FBC, U&E, LFT thyroid function blood glucose CRP B12 and folate CXR MRI/CT head EEG consider
how long does delirium last
can be days-weeks or months
monger in elderly
managing delirium non pharm
educate and tell staff
relaity orientation
correct sensory impairment
bright side room, reduce noise, remove unsafe objects, meet basic needs
pharmacological management delirium
consider practical before but if nothing else then sedate with lorazepam
if alcohol withdrawal then reducing scale BZD, diazepam or chlordiazepoxide
antipsychotics
what is hyperactive delirium
elderly patients ±cog impairment recent injury new confusion, agitation or stress disruptive, delusions or hallucinations of persecution fine during day but not night
what is hypoactive delirium
quiet, withdrawn and sleepy
no eating or drinking, uncooperative, ‘depressed’, not engaging in rehab
what is mixed delirium
mix between hyper/hypoactive delirium
