Delirium

Question 1

What is Delirium?

Answer 1

Acute confusional state which has an underlying cause, has a decline in cognition (consciousness and attention) which is reversible

Symptoms fluctuate

Question 2

Who is at risk of delirium?

Answer 2

Old Age
Post-Hip Fracture
Inpatients/Severe illness
Demented Patients

Question 3

What are the types of delirium?

Answer 3

Hyperactive
Hypoactive
Mixed

Question 4

What are the symptoms of delirium?

Answer 4

Acute Confusion
Withdrawal or Agitation/Aggression
Visual hallucinations
Change in sleep habit (nocturnal)
Short term memory problems

Question 5

What are some causes of delirium?

Answer 5

Medications - diuretics, opioids, Anti-ACh, parkinsons meds, steroids?
Hip #
Infection - UTI and LRTI
MI/Stroke
Endocrine - electolytes (Na+), thyroid, cushings, liver, renal failure

Question 6

How do you treat someone with delirium?

Answer 6

Find and treat underlying cause

Support them:
Quiet room (side room)
Orientate with time and place regularly- give clock
Stop medications and procedures which are not necessary
Don’t use sedatives if possible
Fluids and food
Hearing/Visual aids if needed

Question 7

Investigation of Delirium?

Answer 7

AMT, clock drawing, CAM
Urine Dipstick
Bloods - CRP
CT (rule out stroke)
EEG (brain waves slower)

Question 8

Why care about delirium?

Answer 8

Longer inpatient stays
Worsens QoL
Can persist if not supported
Can reoccur

Question 9

Prevalence of Delirium

Answer 9

20% inpatients

70% ITU elderly

Question 10

Why does it happen?

3 Theories…

Answer 10

1) NT reduced
2) HPA axis - raised cortisol
3) Inflammatory mediators in disease

All disrupt the BBB

Question 11

What is the confusion assessment method?

Diagnosis criteria?

Answer 11

Assesses if:

1) fluctuating
2) inattention
3) thoughts are disorganised
4) altered consciousness

Diagnosis needs 1,2 and either 3 or 4

Question 12

If they require sedation?

Answer 12

Low dose haloperidol

Min drug for minimum time