Delirium Flashcards
What is delirium (3)?
- Syndrome manifesting as acute/fluctuating cognitive impairment associated with
- altered consciousness and
- impaired attention.
- Psychotic features are often present.
- Final common pathway of severe injures to brain/ body and marks illness severity so medical emergency! “Acute brain dysfunction”
Name 4 key diagnostic features and 3 supportive diagnostic features of delirium
- impaired consciousness
- Impaired attention and awareness
- Impaired cognition: disorientation especially to time, memory deficits, language impair, visuospatial, perceptual and thought disturbance
- Acute and fluctuating onset
Supportive: sleep-wake cycle disturbance, mood disturbance, psychomotor changes (hyper/hypo-active)
Name 3 very common medications classes that precipitate delirium
Abo
- Benzodiazepines
- Anticholinergics
- opiates
What is the supposed physiological cause of delirium?
Deficit of ach in reticular formation
Name 8 causes of delirium
TEN DELIRIUM
- Trauma
- Endocrine: thyroid, parathyroid, adrenal dysfunction
- Nutritional deficiencies: thiamine, b12, folic acid
- Drugs: benzos! Alcohol intoxication or withdrawal, anti - acetylcholine!, antihypertensives, antihistamines, steroids, opioids!
- electrolytes: DKA, dehydration, sodium, potassium
- lack of drugs: withdrawal/ intoxication
- Infections: UTI, CNS
- retained faeces
- intracranial: head injury, post-ictal, cva
- urinary retentions
- Metabolic: hyper/hypo glycaemia
Oxygen deficit
Name 5 risk factors for delirium.
ODD LEAPS U
- Old age
- Dementia, depression
- diminished activities of daily living skills /immobility
- labs: low albumin, low hct, glucose disturbance
- excess alcohol
- any condition causing hospitalisation
- Polypharmacy >4; previous stroke
- sensory imparment- visual, auditory
- u-catheter
What is the pharmacological treatment (and dose) for delirium? (2)
- Haloperidol (butyrophenone typical neuroleptic antipsychotic) o,5-1 mg bd = first line but take longer to work.
- lorazepam (benzo) 1-2 mg if agitated. Mainly for withdrawal delirium! Caution in elderly-monitor resp
What is the pharmacological treatment of alcohol withdrawal delirium.? (3)
- Thiamine 1oomg IVI (before glucose drip! Otherwise wernicke encephalopathy), continue po 14 days
- Diazepam 5-10mg 2-4 hourly orally (max 60 mg /day) = 1st line: longer acting.
- Lorazepam 1-2mg IM if very restless - max 6 mg per day
Difference between major and mild neuro cognitive disorder?
Mild cognitive defects don’t interfere with daily function, major does lead to impairment.
Criteria a delirium?
Disturbance in attention and awareness
Criteria B delirium? (Onset)
Develops over short period time (hours to few days), represents change in baseline attention and awareness, and tends to fluctuate during day
Criteria c delirium?
Additional disturbance in cognition eg orientation, memory, visuospatial ability, perception, language, thought and behavioural organisation
Criteria E delirium? (Cause)
There is evidence from history, physical exam or lab findings that disturbance is direct physiological consequence of amc, substance intox or withdrawal, exposure to toxin or due to multiple etiologies
Name 10 specifiers for delirium
- Substance intoxication delirium
- substance withdrawal delirium
- medication-induced delirium
- delirium due to another medical condition
- delirium due to multiple etiologies
/ - acute (lasting hours - days)
- persistent (weeks-months)
/ - hyperactive
- hypoactive
- mixed level of activity
