Delirium Flashcards
What is delirium?
Clinical syndrome of transient + fluctuating global cognitive impairment a/w behavioural abnormalities
Why type of patients is it common in?
Medical and surgical inpatients (10-20%)
Risk factors? (6)
Elderly or very young Pre-exsiting dementia Blind or deaf Post-operative Alchohol (Delirium Tremens) Benzodiazepine treatment
What is the most common aetiology?
Drugs - alcohol, BZD’s, anticholinergics, pscyhotrophics, lithium, diuretics, digoxins, steroids, NSAIDs
Other aetiological causes? (4)
Infective: UTI, L/URTI, abscess, cellulitis
Metabolic: anaemia, electrolyte disturbance, hepatic encephalopathy heart failure
Intracranial - CVA, head injury
Endocrine: DM, hypoglycaemia, pituitary, thyroid, parathyroid or adrenal disease, vitamin deficiency (B12, folate, nicotinic acid)
Clinical features? (12)
Rapid onset with fluctuations:
Fluctuating consciousness and symptoms Poor concentration Memory deficits Sleep disturbance, drowsiness Hallucinations or illusions Sun down syndrome – illusions and delirium when sun sets Agitation Emotional lability Neurological signs Psychotic ideas Withdrawn and quiet
Common types of delirium? (3)
Agitated delirium
Hypoactive delirium
Mixed delirium
Symptoms of agitated delirium?
Agitations Arousal inappropriate behaviour delusions hallucinations
Symptoms of hypoactive delirium?
Retardation
Lethargy
Drowsy
Mixed delirium?
combination of agitated and hypoactive delirium
Investigations?
Mini mental state exam Full exam, including looking for sources of infection FBC, Creatinine – important to assess renal function, U&Es, glucose, calcium, magnesium, cultures O2 sats – hypoxia can cause LFTs, TFTs Urine dip and output Syphilis test ECG
Non-biological Mx? (5)
Rx underlying cause Encourage fluid + nutrition Correct electrolyte disturbances Ensure sensory aids are in place - hearing aids + spectacles Encourage mobilisation
Biological Mx? (3)
Haloperidol 0.5 mg – max 4mg/day (1 week)
Lorazepam 0.5-1mg – max 4mg/day
Risperidone 1-4mg – max 6mg/day
