Delirium

Question 1

definition of delirium

Answer 1

sudden onset (develops over hours - days) acute confusional state that tends to fluctuate during the day

Question 2

cognition changes in delirium

Answer 2

memory deficit disorientation impaired attention language disturbance perceptual disturbance

Question 3

features of -hyperactive delirium -hypoactive delirium

Answer 3

hyperactive = agitated + restless (30%) hypoactive = sleepy + slow (50%) 20% have mixed hypo and hyperactive delirium

Question 4

4 hallmarks of delirium

Answer 4

acute + fluctuating confusion inattention altered level of consciousness disorganised thinking

Question 5

what tool is used to assess patient for delirium

Answer 5

4AT

Question 6

main treatment for delirium

Answer 6

identify + treat underlying cause

Question 7

precipitating events for delirium

Answer 7

DELIRIUMS

Drugs: medical or recreational (opiates, antiepileptics, sedatives, analgesia) + alcohol withdrawal

Eyes and ears: blindness + deafness

Low O2: PE, COPD, anaemia

Infection: UTI, URTI, gastritis

Retention: urine or faecal

Ictal: seizure

Underhydration or undernitrition: thiamine (B1), B12

Metabolic: hypo/hyperglycaemia, hypercalcaemia

Subdural haematoma + stroke

Question 8

should medications be used for management of symptoms in delirium

Answer 8

only if patient is danger to themselves or to others

Question 9

what medication can be used in patients who are agitated with delirium

Answer 9

haloperidol (oral)

Question 10

what type of drug is haloperidol

Answer 10

typical antipsychotic - blocks D2 receptor - extra-pyramidal side effects

Question 11

treatment of agitation in patients with parkinsons/Lewy body dementia

Answer 11

quetiapine 25mg orally - atypical antipsychotic so less likely to cause extra-pyramidal side effects

Question 12

investigations for delirium

Answer 12

Bloods: FBC, U+E, LFT, blood glucose, ABG

Infection screen: urinanalysis, CXR, blood culture

Others: TFT, B12, ECG, EEG