Confusion and Delirium

Question 1

What are risk factors for developing an acute confusional state?

Answer 1

Age > 65 years old,
Background of dementia,
Significant injury (hip fractures),
Frailty or multimorbiditiy,
Polypharmacy

Question 2

What are some causes of acute confusional state/delirium?

Answer 2

Infection (UTI),
Metabolic (hypercalcaemia, hyperglycemia, dehydration)
Change of environment,
Severe pain,
Alcohol withdrawal,
Constipation

Question 3

What are features of delirium?

Answer 3

Memory disturbances,
Agitation,
Disorientation,
Mood changes,
Visual hallucinations,
Disturbed sleep,
Poor attention

Question 4

What is the management of delirium?

Answer 4

Treat underlying cause,
Modify environment,
Haloperidol 0.5mg as first line.
Second line = chlorpromazine

Question 5

What is the mneumonic for the cause’s of Delirium?

Answer 5

DELIRIUMS
Drugs and alcohol (anti-cholinergics, opioids)
Eyes, ears and emotional disturbance
Low output state (MI< respiratory distress, PE)
Infection,
Retention (urinary or stool)
Ictal
Underhydration or under-nutrition
Metabolic disorders,

Question 6

What are the investigations for Delirium?

Answer 6

Blood tests: FBC U&E’s, LFTs, TFTs, urinalysis, cultures.
Imaging - depends on senario,
ECG

Question 7

What factors favour delirium over dementia?

Answer 7

Acute onset,
Impaired consciousness,
Fluctuation of symptoms,
Abnormal perception (hallucinations or illusions),
Agitation or fear,
Delusions