Delirium

Question 1

Define

Answer 1

Acute confusional state secondary to an underlying medical problem

Question 2

Causes of DELIRIUMS - mneumonic

Answer 2

Drugs - medical or recreational (e.g. sedatives and alcohol)

Eyes and ears - blindness and deafness

Low oxygen - PE, COPD, anaemia

Infection

Retention - urine and faecal

Ictal - seizure and post-octal

Underhydration or undernutrition (e.g. b12 deficiency)

Metabolic (electrolytes, hypoglycaemia)

Subdural haematoma and stroke

Question 3

Mimics:

Hypoactive delirium - 2

Another one which is hard to distinguish

Answer 3

Depression
Anxiety

Dementia

Question 4

Hypoactive delirium - symptoms

Hyperactive delirium - symptoms

Mixed just alternating between both

Answer 4

Slow
Withdrawn
Drowsy

Restlessness
Mood lability
Agitation
Aggression

Question 5

2 key features of delirium

Answer 5

Inattention

Lack of concentration

Question 6

Investigations:

Bloods? - 5
Infection screen - 3
Others - 4

Answer 6

FBC
U&E
LFT
blood glucose 
ABG 

Urinalysis
CXR
Blood culture

TFT
B12
ECG
EEG

Question 7

Management:

Environment changes

Look for cause and treat - what does this include?

What can be considered if severely agitated?

Answer 7

Quiet with moderate lighting

Pain
Drugs
Oxygen levels
Urinary/faecal retention

Consider anti-psychotic = haloperidol

Question 8

What does delirium increase your risk of and why?

Answer 8

Dementia

Marker of reduced neurocognitive reserve