Delirium

Question 1

definition

Answer 1

acute confusional state with disturbance in cognitive function in clouded consciousness which is acute in onset and due to demonstrable pathology

Question 2

define clouded consciousness

Answer 2

the patient is awake but has reduced awareness of the environment and is unresponsive

Question 3

common causes of delirium:
I WATCH DEATH

Answer 3

Infections

Withdrawal (delirium tremens)

Acute metabolic- acute uremic encephalopathy,acute hepatic encephalopathy

Trauma-head

CNS pathology-seizure,multiple sclerosis,Parkinsons

Hypoxia states-anaemia,bronchial asthma,COAD,CHF

Deficiencies-thiamine,folate,b12

Endocrinopathies-thyroid diseases,DKA,hypoglycaemia,hyperglycaemia

Acute vascular-ischaemia/infarct

Toxins or drugs

Heavy metals poisoning

Question 4

causes of delirium in alcoholic

Answer 4

alcohol intoxication

delirium tremens

wernicke encephalopathy (thiamine,B1 def)

head injury

hepatic encephalopathy(alcohol liver disease)

undiagnosed DM (hypoglycaemia,ketoacidosis fr chronic pancreatitis)

nutritional def: anaemia,avitaminosis-folate,vitB12,

seizures related to alcohol use (withdrawal fits,head injury,hypoglycaemia,intoxication)

Question 5

symptoms of delirium:10 A

Answer 5

Acute onset with fluctuations in symptoms and lucid intervals

Altered level of consciousness (clouded) with disorientation

Attention and conc impaired

Amnesia of period of delirium

Awake-sleep cycle reversed(sundowning)

Autonomic symp-palpitation,sweating,tremors

Affective changes- anxiety/emotional lability

Agitation or apathy

Altered perceptions-illusions,usually visual & tactile hallucinations

Asso with demonstrable pathology

Question 6

who r at risk?

Answer 6

extreme age grp
mulitple med prob
multiple prescribed meds
substance use disorder inclusing alcohol
medical and surgical inpatients-esp burns
post op
ICU
pre-existing brain damage

Question 7

principles of management

Answer 7

safety
identify cause
correct cause
prevent relapse

Question 8

investigations for all cases

Answer 8

FBC
ESR
BUSE
RBS
ECG
CXR
LFT
renal profile
urine FEME

Question 9

clnically indicated investigations

Answer 9

ABG
EEG
CT
CSF ANALYSIS
TFT
blood/urine cultures and toxicology
HIV screening
VDRL
screening for autoimmune disorders