Delirium Flashcards
Hepatic encephalopathy: hypoactive or hyperactive delirium?
Hypoactive
What do serial 7’s test for?
Attention. Can also do WORLD backwards or months of the year backwards.
What etiologies are there for hyperactive delirium?
Withdrawal from sedatives or intoxication with stimulants/hallucinogens.
What etiologies are there for hypoactive delirium?
Hepatic encephalopathy, hypercapnia. Often missed because patient is quiet and dozing. Worse prognosis: more common in elderly.
What etiologies are there for mixed level of activity delirium?
Daytime sedation with nocturnal agitation and wakefulness. Has many etiologies.
What is hypoactive delirium often confused with?
Depression
What is hyperactive delirium often confused with?
Mania
Can delirium cause permanent damage?
Yes becuase it is directly neurotoxic.
Epidural hematoma classic sign
injury, then unresponsive a few hours later.
What is the risk of drawing LP if there is already increased intracerebral pressure?
Central herniation and death.
Giving thiamine before dextrose
important because dextrose can precipitate neuronal injury by driving existing low levels of circulating thiamine intracellularly.
Chronic exposure to alcohol leads to :
Up reg of excitatory NMDA glutamatergic receptors , down reg of inhibitory gaba receptors, and increase in central NE activity.
What cardiac finding is common in alcohol withdrawal?
A fib, grab an EKG.
Which ocular changes are present in Wernicke’s Encephalopathy?
Abducens nerve paralysis and nystagmus.
How does thiamine deficiency work?
Plays a role in 3 enzyme systems. Leads to failure of metabolic system leading to cell death in heart and brain.
Classic clinical triad of Wernicke
1) Encephalotpahty (delirium)
2) Gait ataxia (wide based gait)
3) Oculomotor dysfunction (incomplete opthlamoplegia)
At what point do you add “Korsakoff?”
Amnesia with CONFABULATION. Seqeulae of wernicke.
Treatment of Wernicke Korsakoff?
Thiamine 100 mg IV bolus, then 50-100 mg 5/day. Given thiamine before glucose. Give mag sulfate. Then give glucose.
Why do low recovery rates happen in Wernicke K?
Neuronal death has occurred by the time clinical symptoms appear
How is wernicke different from NPH?
Wernicke will have opthalmoplegia while NPH has urinary incontinence. Both have ataxia. NPH is neurocognitive disorder and WN is encephalopathy.
Role of physostigmine
Phosphodiesterase used in anticholinergic toxicity. Prevents the breakdown of ACH.
