Delirium

Question 1

What is the mnemonic to remember the causes of delirium?

Answer 1

DELIRIUM

Drugs
Electrolyte imbalance/environment 
Lack of drugs (withdrawal) 
Infection 
Reduced sensory input (hard of hearing)/pain 
Intracranial 
Urinary and faecal retention 
Metabolic

Question 2

Anyone over the age of what should be screened for delirium?

Answer 2

> 65

Question 3

Delirium can present as hyper or hypo active. Describe what is meant by each?

What is the more dangerous form?

Answer 3

Hyperactive

• Aggresive
• Agitated
• Hallucinations
• Delusions

Hypoactive

• V sleepy
• Confused
• Easily distracted
• Slow
• lethargy

Hypoactive is far far more commonly missed

Question 4

Give an example of two drugs which can cause delirium

Answer 4

Coedine and tamsulosin

Question 5

How long does it take to recover?

How would you be able to tell the difference between delirium and dementia?

Answer 5

Days to months

Dementia would have an insidious onset and people would slowly decline

Delirium is acute and sudden

Question 6

Explain how you would investigate the cause of delirium as if to an examiner?

Answer 6

Bloods

• testing everything
• inc. blood sugars

Examination

• general obs
• neuro exam
• if any pain examination of that system

ECG

Polypharma
- review all meds and see if any have recently been started

Bowel and bladder chart
- check to see if in retention/constipated

Urine infection?
- Dipstix (note: bacteria is found asymptomatically in a lot of cases so need symptoms too to diagnose)

Take a history from patient + collateral history from carer or fam

Imaging

• CT if head trauma
• CXR if chest symptoms
• Bladder US if in retention

Question 7

The cause of delirium is normally always multifactorial. T/F

Answer 7

T

Question 8

If patient is incredibly agitated and can not be calmed and sedation seems like the most appropriate action. What drug is given?
What are the contradictions to this drug?
What should be given instead?

Answer 8

Haloperidol 0.5mg

DO NOT give in Parkinson’s/Lewy body dementia as is a dopamine blocker -> makes condition worse

Lorazepam

Question 9

In a patient with diminishing capacity what chart should be filled out?

Answer 9

AWI (adults with incapacity)

Question 10

What is the scoring system that can be used to see if someone is likely to have delirium?

Answer 10

4-AT

Question 11

What is so important about ward environment for a delirious patient?

Answer 11

Move them as little as poss
Keep space familiar with pictures of fam etc
Keep quiet