Delirium Flashcards
Define delirium
Acute, transient, global organic disorder of CNS function, resulting in impaired consciousness and attention
What are the 3 subtypes of delirium? Which is most common?
Hypoactive - most common
Hyperactive
Mixed
Outline the key features of hypoactive delirium
Lethargy
Sleepiness
Decreased motor activity and speech
Apathy
Outline the key features of hyperactive delirium
Agitation/aggression
Disorientation/wandering
Psychosis
List 5 RFs for delirium
- Aged 65+, especially if lots of co-morbidities or frail
- Dementia
- Renal impairment
- Sensory impairment
- Male
- Post-op or severely unwell
- Previous episodes
List 8 causes of delirium
- Hypoxia
- Endocrine
- Infection
- Stroke
- Nutrition
- Post-op
- Pain
- Metabolic
- Substance withdrawal
- Sleep deprivation
What are the 5 key clinical features of delirium according to the ICD-10 classification?
Give examples for each
Acute onset and fluctuating course of the following:
- Impairment of consciousness/attention - e.g. loss of focus
- Global disturbance of cognition - e.g. memory loss, hallucinations, speech problems
- Psychomotor abnormalities - e.g. increased startle reaction
- Sleep-wake cycle disturbances - e.g. vivid dreams, insomnia
- Mood disturbance
What should you do before taking a history?
- A to E
- Nutritional/hydration status
- CVS exam
- Resp exam
- Abdo exam
- DRE
- Neuro exam
What should you ask about in the history?
- Onset and course of confusion
- Other symptoms
- Premorbid mental state
- Psychotic symptoms
- Drug and alcohol hx
List 5 blood tests you would do when investigating delirium, and why
- FBC - infection
- U+E - electrolyte disturbance
- LFTs - alcoholism
- Calcium - hypercalc
- Glucose - hypo
- CRP - infection
- TFTs - hyperthyroid
Give 3 DDx for delirium
- Dementia
- Depression
- Late onset schizophrenia
- Hypo/hyperthyroid
- Dissociative disorders
Outline the management of delirium (5 marks)
- Treat underlying cause, e.g. infection
- Review meds - stop any precipitating drugs
- Laxatives/catheter
- Quiet, well-lit side room
- Glasses/hearing aids
- Clock/calendar
- Encourage oral intake
- Avoid BZDs
- Consider low-dose Haloperidol or Olanzapine
- Zopiclone for sleep
- Refer to geriatricians
Give 5 differences between delirium and dementia
- Delirium acute onset, dementia gradual
- Delirium lasts hours to weeks, dementia months to years
- Delirium has fluctuating course, dementia progressive
- Delirium = impaired consciousness, dementia normal consciousness level
- Delirium - more commonly psychotic features than dementia
- Delirium more likely to affect sleep cycle
