Delirium Flashcards
What is delirium?
A temporary mental state characterized by confusion, anxiety, incoherent speech, and hallucinations.
What are the two states of delirium?
Hyperactive
Hypoactive
What are clinical features of hyperactive delirium?
Agitation
Delusions
Hallucinations
Wandering
Aggression
What are the clinical features of hypoactive delirium?
Lethargy
Slowness with everyday tasks
Excessive sleeping
Inattention
How is delirium caused?
A change in environment coupled with sensory impairment (common in the elderly) increases the risk of developing delirium.
Constipation
Hypoxia
Infection
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction (hepatic or renal impairment)
Nutrition
Environmental changes
Drugs (over the counter, illicit, alcohol and smoking)
What cognitive assessment is used to assess a delirious patient?
Abbreviated Mental Test Score (AMTS)
What is the Abbreviated Mental Test Score (AMTS) used for?
This tool can be used to objectively monitor for improvement or deterioration in cognitive function over time.
What other screening cognitive assessments can be used to assess delirium?
MMSE and ACE-III.
What examination should be carried out on a suspected delirious patient?
Vital signs (e.g. fever in infection, low SpO2 in pneumonia)
Level of consciousness (e.g. GCS/AVPU)
Evidence of head trauma
Sources of infection (e.g. suprapubic tenderness in urinary tract infection)
Asterixis (e.g. uraemia/encephalopathy)
What is a ‘confused screen’
This panel of investigations is useful for identifying or ruling out common causes of confusion.
Blood tests
Urinalysis
Imaging
What blood test would be run?
FBC (e.g. infection, anaemia, malignancy)
U&Es (e.g. hyponatraemia, hypernatraemia)
LFTs (e.g. liver failure with secondary encephalopathy)
Coagulation/INR (e.g. intracranial bleeding)
TFTs (e.g. hypothyroidism)
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics (e.g. B12/folate deficiency)
Glucose (e.g. hypoglycaemia/hyperglycaemia)
Blood cultures (e.g. sepsis)
What is involved in urinalysis for delirium?
UTI is a very common cause of delirium in the elderly.
A positive urine dipstick without clinical signs is NOT satisfactory to diagnose urinary tract infection as a cause of delirium.2, 3
Look for other evidence supporting the diagnosis (WCC↑/supra-pubic tenderness/dysuria/offensive urine/positive urine culture).
What imaging and when is it used in delirium?
CT head: if there is concern about intracranial pathology (bleeding, ischaemic stroke, abscess)
Chest X-ray: may be performed if there is concern about lung pathology (e.g. pneumonia, pulmonary oedema)
What is definitive management of delirium?
Definitive management of delirium involves identifying and treating the underlying cause
