Delirium Flashcards
A diagnosis of delirium requires
Disturbance in consciousness and disruptions of attention
Changes in cognition or perceptual disturbance not accounted for by existing illness
Acute onset with fluctuations over the day
Must be occurring secondary to another medical condition
Delirium is also know as
Acute confusional state Acute brain syndrome/dysfunction Toxic-metabolic encephalopathy ICU psychosis Cerebral insuffiency
Delirium is
An organic cerebral syndrome of acute dysregulation of neuronal membrane function due to impairment of the oxidative metabolism.
This causes a neurobehavioural syndrome characterised by concurrent disturbance of consciousness, attention, perception, thinking, memory, psychomotor behaviour and sleep.
Features of delirium
Central feature is global impairment of consciousness
Associated features include:
- lack of awareness of surroundings (disorientation in time and space)
- problems with attention, memory or speech
- may have visual hallucinations
- duration less that six months
- at least one sleep cycle disturbance
- psychomotor disturbances
- evidence of underlying pathology
Delirium occurs in the
Elderly Medically Ill sensory impairment Very young (febrile delirium) Post op (esp cardiac) Burns victims Benzo dependent Pre-existing dementia Polypharmacy
Metabolic causes of delirium
Drugs (withdrawal) Endocrine changes (thyroid, adrenal) Electrolytes (Na,Ca, dehydration) Vitamins (B12, thiamine) Pain
Causes of delirium
Infections Metabolic Organ failure Cerebrovascular Neoplastic Trauma Substance misuse Delirum Tremens or alcohol induced delirium is separate.
Delirium due to organ failure
Liver
Renal (uraemia in dialysis)
Hypoxia in resp failure, suppression in over-sedation/anaesthesia
Head injury
Cerebrovascular causes of delirium
Stroke or TIA
Hypertensive encephalopathy
Hypotension
DIC or TTP
Treating delirium
Treat underlying condition
Close observation of at risk people
Managing delirium
If agitated –> quite dim room (avoid unnecessary sedation)
If calm but confused –> good lighting, visible clues to orientation, simple explanations of procedures
Treat underlying cause
Also - continuity of care and support by family and friends
Consequences of Delirium
50% mortality at one year and may be a marker of subsequent dementia
Subtypes of delirium
Hyperactive – agitation, delusion and disorientation.
Hypoactive – reduced motor activity, lethargy. Poor prognosis
Mixed - can present with a mixed picture or vary from hypo- to hyper active etc
Delirium in hospital
Medically Ill (10-20% of inpatients, 15-33% will experience post-op delirum and 70-80% of ITU cases)
Sleep wake cycle disturbances in delirium
Insomnia, inversion of sleep cycle, nocturnal worsening, nightmares which continue as hallucinations
