Delirium

Question 1

What are the three subtypes of delirium

Answer 1

Hyperactive - increased psychomotor activity, restlessness, agitation.
Hypoactive - Lethargy, reduced responsiveness and withdrawal.
Mixed: Both hyperactive and hypoactive.

Question 2

What are the causes of Delirium?

Answer 2

D - Drugs and alcohol (anti-cholinergics, opioids)
E - Ears, eyes and emotional disturbance
L - low output state (MI, ARDS, PE)
I - Infection
R- Retention (urine or stool)
I - Ictal (related to seizure activity)
U - Underhydration or undernutrition
M - Metabolic (electrolytes, thyroid).
S - Subdural haematoma

Question 3

What is the presentation of delirium?

Answer 3

Disorientation,
Hallucinations,
Memory problems,
Change in mood or personality,
Disturbed sleep

Question 4

What are the investigations for Delirium?

Answer 4

4ST and CAM.
Bedside: Bladder scan, review meds, Urine MC&S (not dipstick in over 65s)
Bloods: FBC, U&Es, LFTs, TFTs, Blood cultures
Imaging: CXR, abdo US, CT/MRI in those with unidentifiable cause

Question 5

What is the management of delirium?

Answer 5

Treat underlying cause
Non-pharmacological: Good lighting, regular orientation and reassurance.
Pharmacological: Haloperidol

Question 6

What symptoms favour delirium over dementia?

Answer 6

Acute onset,
Impaired consciousness,
Fluctuation of symptoms,
Abnormal perception,
Agitation/fear,
Delusions