Delirium (acute confusional state)

Question 1

Definition

Answer 1

Delirium is defined as a non-specific organic brain syndrome or acute brain dysfunction or acute brain failure within the setting of physical illness- medical or surgical

Question 2

Pathophysiology

Answer 2

Not well understood, but evidence for cholinergic underactivity and dopaminergic overactivity. Increased acitivity in the hypothalamic-ptuitary axis with increased cortisol levels

Question 3

8 Signs of delirum

Answer 3

Delirium

• Disordered thinking: slow, irrational, rmabling, jumbled up, incoherent ideas
• Euphoric, fearful, depressed or angry
• Language impaired: speech is reduced or gabbling
• illusions/ delusions/hallucinations: tactile or visual
• reversal of sleep-awake cycle: may be drowsy by day and hypervigiliant at night
• Inattention- Focusng, sustaining, or shifting attention is poor, no real dialgoue
• Unaware/ disorenited: Doesnt know its evening or his own name or location
• memory deficits: Often marked (later he may be amnesc for the episode)

Summary: globally impaired cognition and impaired weakness/consciousness

Question 4

Causes

Answer 4

• Systemic infection : pneumonia, UTI
• intracranial infection: encephaliyis, meningitis
• Drugs: opiates, anticonvuslants
• alcohol withdrawl: (2-5 days post admission)
• Metabolic: uraemia, liver failure
• Hypoxia: Respiratory or cardiac failure
• Vascular: stroke, MI
• Head injury: Increased ICP, space-occupying lesions
• Epilepsy: non convulsive status epilepticus
• Nutritional: Thiamise, nicotnic acid, or B12 deficnecy

Question 5

Tests

Answer 5

• FBC
• U& E
• LFT
• Blood glucose
• ABG
• septic screen (urine dipstick, CXR, blood cultures)
• ECG, malaria films

Question 6

Management

Answer 6

• Identify and treat the underlying cause
• Reduce distress and prevent accidents; encourage family to sit with the patient
• nurse ina moderately lit, quiet room, ideally with the same staff in attendance
• do not use physical restrainst- and remove catheters
• augement self care- discourage passive dependency and inappropriate napping
• use the 3m non-drug cure for agitation: Music, Massage, Muscle relaxation
• Minimise medication (haloperidol 0.5-2mg wait 20 min then review)