Delirium Flashcards
What is delirium?
acute, fluctuating change in mental status, with inattention, disorganised thinking, and altered levels of consciousness
Give 5 features that differentiate delirium from dementia
Acute onset
Fluctuating
Reversible
Altered consciousness
Inattention + lack of concentration
What are the 3 types of delirium?
Hyperactive
Hypoactive
Mixed
What symptoms/ signs are seen in all types of delirium?
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
Give 3 features of hyperactive delirium
Restlessness
Abnormal perception (e.g. illusions + hallucinations)
Increased psychomotor activity: agitation
Give 4 features of hypoactive delirium
Lethargy
Decreased psychomotor activity
Incoherent speech
Lack of interest
What is the prevalence of delirium in over 65s in hospital?
Up to 50%
Give 7 risk factors for delirium
Age >65yrs
Multiple co-morbidities
Underlying dementia
Renal impairment
Male gender
Sensory impairment (hearing or visual)
Polypharmacy
Give 9 causes of delirium
Acute infection
Metabolic
Drugs
Surgical
Toxic substances
Withdrawal
Acute vascular
CNS pathology
Hypoxia
Give 3 types of infections that can cause delirium
UTI
Pneumonia
Meningitis
Give 5 metabolic causes of delirium
Liver/ kidney failure
DKA
Hyper/hypothyroidism
Vitamin B12/ folic acid/ thiamine deficiency
Electrolyte abnormalities
Give 3 drugs that can cause delirium
Anticholinergics
Benzodiazepines
Opioids
Give 5 other causes of delirium
Dehydration
Urinary retention
Sleep deprivation
Trauma
Major surgery
What bloods should be performed in delirium?
FBC: Infection
U&Es: dehydration, electrolyte disturbance
Ca2+:
TFTs: hypo/ hyperthyroidism
Glucose: hypoglycaemia
B12 + folate: deficiencies
What other investigations may be performed in delirium?
Blood cultures +/- wound swabs
Urinalysis: UTI
CXR: pneumonia
CT head: CNS pathology
What bedside measures can be used to investigate delirium?
AMTS
Review obs + drug chart
Examine for signs of infection
Examine for urinary retention/ constipation/ dehydration
Examine for pain
Neuro exam
How should delirium be managed?
Treat the cause: Abx, stop causative drug, laxatives, urinary catheter, oxygen, analgesics, antipyretics, IV fluids
Reassure + reorientate
Fall prevention
What medical management can be used in delirium?
Haloperidol PO (1st line)
Lorazepam
What 4 features indicate delirium?
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.
