Delirium

Question 1

What are the types of delirium?

Answer 1

Hypoactive - lethargy and reduced motor activity
Hyperactive - agitation and increased motor activity
Mixed - fluctuations throughout the day

Question 2

What are the differences between delirium and dementia?

Answer 2

Onset - delirium = acute, dementia = insidious

Short term course - delirium fluctuating, dementia - constant

Attention - delirium =poor, dementia = good

Delusions and hallucinations - delirium = common, simple, fleeting, dementia = less common, more stable

Question 3

What are the risk factors for delirium?

Answer 3

Age >65
Multiple co-morbidity
Underlying dementia
Renal impairment
Male
Sensory impairment

Question 4

What are common causes for delirium?

Answer 4

Hypoxia post-operatively
Infection (UTI//LRTI most common)
Drug induced (bentos, diuretics, opioids, steroids)
Drug withdrawal (alcohol, bentos)
Dehydration/Pain
Constipation or urinary retention
Endocrine abnormalities (hypoNa, hyperNa, hypercalcaemia)

Question 5

What should you ascertain from history?

Answer 5

Collateral hx may be required
Onset and course of confusion
Symptoms of underlying cause
Co-morbidities and baseline cognistion
Previous episodes
Drug history (alcohol)

Question 6

What can be used to assess cognitive function?

Answer 6

MMSE/Abbreviated mental test:
Age, time, address for recall at end of test, year, home address, two persons/objects, DOB, year of WW12, current monarch, 20-1
Confusional assessment method

Question 7

What examinations would you perform?

Answer 7

Review abs, drug chart, infection signs, surgical site, pain, constipation/urinary retention
Neurological exam for stroke/subdural haematoma

Question 8

What investigations for delirium?

Answer 8

Confusion screen:
Bloods (FBC, U&E, Caclium, TFTs, glucose, B12, folate
Blood cultures, wound swabs
Urinalysis, CXR
CT head

Question 9

How to manage delirium?

Answer 9

Identify and treat cause
Nurse in quiet area, regular routines, clocks to orientate to time/place, regular sleeping
Encourage oral fluid intake, provide analgesia and monitor bowels

Haloperidol is 1st line treatment - oral first then IV