Delirium (acute confusional state)

Question 1

what is delirium?

Answer 1

an acute and fluctuating disturbance in level of consciousness, attention and global cognition

treat promptly to avoid potential brain damage.

Question 2

signs and symptoms of delirium

Answer 2

Reduced level of consciousness;

Psychiatric symptoms:

• Disorientation (time/place/person);
• Inattention;
• Illusions/hallucinations;
• Altered personality;
• Mood disorders;
• Speech disorders (slurred speech/aphasic error/chaotic pattern).

Lacking insight.

fluctuate.

Question 3

causes of delirium

Answer 3

CVS- stroke, abscess, tumor, subdural haematoma

drugs- withdrawal, anticholinergics, antiemetics, antipsychotics, corticosteroids, digoxin, levodopa, TCA, opioid, alcohol

endocrine- hyperparathyroidism, hyper/hypothyroidism

infection/injury
encephalitis, meningitis, pneumonia, sepsis, UTI, burns, hypothermia

metabolic:
acid-base disturbance
hepatic encephalopahty
uraemia
hypo/hyperglycaemia
electrolyte imbalance
thiamine/vitamin b12 deficiency

post-op state
mental disorder
sleep deprivation

Question 4

management of delirium

Answer 4

treat underlying cause
remove any aggravating drugs
environmental management
minimise sensory deficits

haloperidol 0.5-1.0mg PO
lorazepam 0.5-1.0mg PO