Delirium

Question 1

What is delirium?

Answer 1

acute, fluctuating change in mental status, with inattention, disorganised thinking, and altered levels of consciousness

Question 2

Give 5 features that differentiate delirium from dementia

Answer 2

Acute onset
Fluctuating
Reversible
Altered consciousness
Inattention + lack of concentration

Question 3

What are the 3 types of delirium?

Answer 3

Hyperactive
Hypoactive
Mixed

Question 4

What symptoms/ signs are seen in all types of delirium?

Answer 4

Disturbance in attention
Change in cognition
Acute change from baseline + fluctuating
Sleep-wake cycle often reversed
Evidence from Hx, exam or labs that disturbance is a physiological consequence

Question 5

Give 3 features of hyperactive delirium

Answer 5

Restlessness
Abnormal perception (e.g. illusions + hallucinations)
Increased psychomotor activity: agitation

Question 6

Give 4 features of hypoactive delirium

Answer 6

Lethargy
Decreased psychomotor activity
Incoherent speech
Lack of interest

Question 7

What is the prevalence of delirium in over 65s in hospital?

Answer 7

Up to 50%

Question 8

Give 7 risk factors for delirium

Answer 8

Age >65yrs
Multiple co-morbidities
Underlying dementia
Renal impairment
Male gender
Sensory impairment (hearing or visual)
Polypharmacy

Question 9

Give 9 causes of delirium

Answer 9

Acute infection
Metabolic
Drugs
Surgical
Toxic substances
Withdrawal
Acute vascular
CNS pathology
Hypoxia

Question 10

Give 3 types of infections that can cause delirium

Answer 10

UTI
Pneumonia
Meningitis

Question 11

Give 5 metabolic causes of delirium

Answer 11

Liver/ kidney failure
DKA
Hyper/hypothyroidism
Vitamin B12/ folic acid/ thiamine deficiency
Electrolyte abnormalities

Question 12

Give 3 drugs that can cause delirium

Answer 12

Anticholinergics
Benzodiazepines
Opioids

Question 13

Give 5 other causes of delirium

Answer 13

Dehydration
Urinary retention
Sleep deprivation
Trauma
Major surgery

Question 14

What bloods should be performed in delirium?

Answer 14

FBC: Infection
U&Es: dehydration, electrolyte disturbance
Ca2+:
TFTs: hypo/ hyperthyroidism
Glucose: hypoglycaemia
B12 + folate: deficiencies

Question 15

What other investigations may be performed in delirium?

Answer 15

Blood cultures +/- wound swabs
Urinalysis: UTI
CXR: pneumonia
CT head: CNS pathology

Question 16

What bedside measures can be used to investigate delirium?

Answer 16

AMTS
Review obs + drug chart
Examine for signs of infection
Examine for urinary retention/ constipation/ dehydration
Examine for pain
Neuro exam

Question 17

How should delirium be managed?

Answer 17

Treat the cause: Abx, stop causative drug, laxatives, urinary catheter, oxygen, analgesics, antipyretics, IV fluids
Reassure + reorientate
Fall prevention

Question 18

What medical management can be used in delirium?

Answer 18

Haloperidol PO (1st line)
Lorazepam

Question 19

What 4 features indicate delirium?

Answer 19

An acute confusional state.
A change in perception e.g. visual or auditory hallucinations.
A change in physical function e.g. reduced mobility, agitation, sleep disturbance.
A change in social behaviour e.g. withdrawal, lack of co-operation for reasonable requests, alterations in mood, change in communication/attitude.