Delirium

Question 1

What tests are performed as part of a ‘confusion screen’?

Answer 1

B12/folate - deficiency can worsen confusion
TFTs - hypothyroidism is associated with confusion
Glucose - hypoglycaemia can cause confusion
Bone profile (calcium) - hypercalcaemia can cause confusion

Question 2

What is delirium?

Answer 2

An acute organic syndrome of the brain manifesting with:

Memory disturbance - loss of short term > long term
Agitated or withdrawn
Disoriented
Mood change
Visual hallucination, delusions
Disturbed sleep cycle - ‘sundowning’ = becoming awake at night
Poor attention

Question 3

What are some risk factors for delirium?

Answer 3

Age >65

Background of dementia

Significant injury e.g. hip fracture

Frail or multimorbidity - significant cardiovascular, respiratory, neurological or endocrine condition

Polypharmacy

Question 4

What are some precipitating events for delirium?

Answer 4

Infection - esp. UTI

Metabolic changes - hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration

Change of environment

Severe pain

Alcohol withdrawal

Constipation

Question 5

How do you manage delirium?

Answer 5

Manage underlying cause - will hopefully self resolve shortly following (but can persist)

Modification of environment - big clocks, photos, regular checking from familiar people etc

Haloperidol or olanzapine for agitation (unless have Parkinson’s, then lorazepam)