Delirium (EL) Flashcards
Define delirium.
Syndrome of acute confusion characterised by fluctuations in attention, cognition and awareness
Acute fluctuating change in mental status with inattention, disorganised thinking and altered levels of consciousness
Which demographics are most susceptible to delirium? (2)
- elderly patients >65y
- hospitalised patients
What is delirium typically secondary to? (9)
- infection (UTIs, pneumonia)
- metabolic (hypercalcaemia, hypoglycaemia, hyperglycaemia, hyponatraemia, dehydration)
- change in environment
- severe pain
- trauma (hip fractures)
- drugs
- alcohol withdrawal
- constipation
- urinary retention (may be due to BPH - suprapubic distension and weakness)
What acronym can be used to help us remember the causes of delirium?
PINCH ME
- Pain
- Infection
- Nutrition
- Constipation
- Hydration
- Medication
- Environment / Electrolytes
Which brain regions might be involved in delirium? (6)
- prefrontal cortex
- subcortical structures
- thalamus
- basal ganglia
- lingual gyri
- frontal, fusiform and temporoparietal cortex
What might contribute to delirium pathophysiology? (3)
- cholinergic deficiency, dopaminergic excess and other neurotransmitters
- interleukins 1&2 and TNF-alpha and interferon
- chronic hypercortisolism (as induced by chronic stress secondary to illness of trauma)
Define delirium tremens.
Extreme form of acute alcohol withdrawal developing around 72 hours after ceasing alcohol intake
How does delirium tremens present?
Hallucinations and fluctuating consciousness levels
How do we treat delirium tremens? (2)
Chlordiazepoxide and Pabrinex
What are the clinical features of delirium? (7)
- disturbance in attention
- change in cognition
- develops over short period of time
- disturbance caused by direct physiological consequences of general medical condition, substance intoxication/withdrawal
- hallucinations
- agitation
- severity of Sx fluctuates throughout day and worsens in evening
What differentiates delirium from dementia?
ACUTE alteration in level of awareness and attention (decreased consciousness)
What are the types of delirium? (4)
- hypoactive (25%) - decreased psychomotor activity - withdrawn, lethargic, slow to respond, lack of interest
- hyperactive (75%) - increased psychomotor activity - restless, agitation, hallucinations, inapt behaviour
- mixed delirium
- sub-syndromal delirium - partially resolved/incomplete forms of delirium
Compare delirium vs dementia.
- onset: sudden, prodromal phase might precede VS insidious
- course: rapid and fluctuating, hours to days VS slowly progressive deterioration, months to years
- level of consciousness: decreased VS intact
- attention: impaired (fluctuating) VS usually alert, impaired in advanced phase
- memory: recent memory loss VS recent then remote memory loss
- thought process: disorganised VS impoverished
- hallucinations: present (often visual or tactile) VS can be present in advanced disease
- psychomotor activity: increased/decreased VS usually normal
- EEG: usually abnormal VS usually normal
- reversibility: reversible VS irreversible
What is needed for diagnosis of delirium?
All 4 of below AND not accounted for by previous dementia/other conditions:
- disturbance in attention (lethargy, distractability)
- change in cognition (memory deficit, disorientation, language disturbance)
- develops over short period of time (usually hours to day and fluctuates)
- disturbance is caused by the direct physiological consequences of a general medical condition, substance intoxication or substance withdrawal
What are some risk factors for delirium? (5)
- age >65
- background of dementia
- significant injury
- frailty or multimorbidity
- polypharmacy
