Delirium Flashcards
What is delirium?
Delirium is an acute and fluctuating disturbance in attention and cognition, often accompanied by a change in consciousness.
It is typically reversible and frequently seen in the elderly, particularly in inpatient settings.
What are the 3 main delirium subtypes?
Hyperactive Delirium: Marked by increased psychomotor activity, restlessness, agitation, and hallucinations.
Hypoactive Delirium: Characterised by lethargy, reduced responsiveness, and withdrawal.
Mixed Delirium: Combines features of both hyperactive and hypoactive delirium.
Who is delirium most common in?
Delirium is a common condition, predominantly affecting elderly people, and is seen in up to 30% of elderly inpatients.
What is the mnemonic for remembering causes of delirium?
Cause of delirium is mainly multifactorial.
Mnemonic: DELIRIUMS
What are the components of the “DELIRIUMS” mnemonic?
D: Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E: Eyes, ears and emotional disturbances
L: Low Output state (Myocardial Infarction, Acute Respiratory Distress Syndrome, Pulmonary Embolism, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease)
I: Infection
R: Retention (of urine or stool)
I: Ictal (related to seizure activity)
U: Under-hydration/Under-nutrition
M: Metabolic disorders (Electrolyte imbalance, thyroid disorders, Wernicke’s encephalopathy)
(S): Subdural hematoma, Sleep deprivation
What are the signs and symptoms of delirium?
can present in a number of different ways, including:
- Disorientation
- Hallucinations - visual or auditory
- Inattention
- Memory problems
- Change in mood or personality.
- Sundowning = agitation and confusion worsening in the late afternoon or evening.
- Disturbed sleep
What are initial investigations for delirium?
Initial investigations should include a comprehensive physical examination and infection screen.
What are some additional investigations for delirium?
Bedside - bladder scan, review medications, ECG (arrhythmias, ischaemic changes that could cause hypoperfusion) urine MC&S - you should not perform urine dipstick if >65 as they are less sensitive in this age group.
Bloods: FBC, urea and electrolyes, liver function tests, thyroid function tests, and blood cultures.
Imaging: chest X-ray, or ultrasound of the abdomen. Neuroimaging with CT or MRI head is reserved for those without a clear identifiable cause.
What are the non-pharmacological (first line) treatments for delirium?
Providing an environment with good lighting
Maintaining a regular sleep-wake cycle
Regular orientation and reassurance
Ensuring the patient’s glasses and hearing aids are used if needed
What pharmacological treatments can be used for delirium?
For patients who are extremely agitated and potentially a danger to themselves or others, pharmacological interventions such as small doses of haloperidol or lorazepam.
Olanzapine can also be used however should be checked for elderly as it poses with great side-effects.
What is delirium tremens?
Delirium tremens is a life-threatening condition characterised by a rapid onset of confusion often precipitated by alcohol withdrawal.
How long after alcohol withdrawal does delirium tremens tend to occur and how long does it persist for?
Generally develops around 72 hours after the cessation of alcohol intake and can persist for several days.
When do symptoms of delirium tremens usually peak?
Between 4th and 5th day post withdrawal
Signs and symptoms of delirium tremens?
Confusion and disorientation
Hallucinations, which can be visual or tactile (e.g., formication – the sensation of crawling insects on or under the skin)
Autonomic hyperactivity, manifesting as sweating and hypertension
Rarely, seizures
Management of delirium tremens?
Administer Chlordiazepoxide.
Ensure adequate hydration with fluids
Provide Anti-emetics to manage nausea
Pabrinex to replenish vitamins
Refer the patient to local drug and alcohol liaison teams for further
support and management
