DELIRIUM Flashcards
What are the different causes of dementia?
Neurological - stroke, SOL, seizure, meningitis, hypertensive encephalopathy
Infectious - systemic infectious e.g UTI, pneumonia, cellulitis
Iatrogenic
- anti cholinergics and psychotropics e.g. Opioids, benzodiazepines
- drug and alcohol abuse and poisons
Endocrine - hypo/hyperglycemia, hypo/thyroidism
Metabolic - organ failure, electrolyte disturbances, vitamin deficiencies
MNEUMONIC - DEMENTIA
What is delirium?
A state of acute confusion over hours-days.
- inattention
- decreased cognition
- fluctuating mental state
- fluctuating consciousness
RFs for delirium?
Co-morbidities
- older age and pre-existing dementia are main RFs
In hospital - bladder catheterization, sleep deprivation, polypharmacy
Surgical - inadequate or excessive analgesia, procedures involving cardiopulmonary bypass?
What is the relationship between delirium and dementia?
2/3 of patients with delirium have pre-existing dementia.
What are the types of delirium?
Hyperactive e.g delirium tremens
- psychosis - agitation - hyperarousal - autonomic instability
Hypoactive e.g opioid intoxication
- withdrawn - quiet - apathetic - psychomotor slowing
What is delirium tremens?
An acute episode of delirium usually caused by withdrawal from alcohol.
Treated by benzodiazepines. But benzo treatment can also cause it.
How do you diagnose delirium?
Clinically. Can use Confusion Assessment Method (CAM) but it is imperfect. - acute onset with fluctuating course - inattention - disorganized thinking - altered LOC
What is the digit span test?
Ask patient to repeat sequence of numbers.
What is your management of delirium?
Non-pharmacological
- regular reorientation
- glasses and hearing aids
- sun downing to fix sleep wake cycle
- early mobilization to minimize time in bed
Pharm (avoided as much as possible)
- identify underlying cause and treat
- atypical antipsychotics (haloperidol and respiridone) for uncontrolled agitation.
How to take a history of delirium?
WIIP including she, living situation and support
Symptoms of delirium - hypo or hyper
Symptoms of underlying cause - infection, systems review
Ask others - baseline cognition, nurse,
PMHx - medications, pain score
FHx - dementia
Ix?
CBE EUC LFT BGL urinalysis
TFTs, B12, folate, thiamine
Toxin screen, specific infection tests.
EEG
CXR for pneumonia, PO
Atypical a have less extra pyramidal side effects
Usually increase risk of ischemia stoke and increase QT interval, pneumonias
Respiridone is recommended
Quietus pine is used in PD, more prone to hypotension and already autonomic ally dysfunctional
All sedating
Benzoa only for alcohol withdrawal and sedate patients before interventions
Prog - increased risk of functional and cognitive decline
Increased mortality risk esp with hypo active.
