Delirium Flashcards
(14 cards)
Definition of delirium
Acute confusional state with impaired cognition, attention, and consciousness; acute onset, fluctuating, worse at night
Is delirium reversible?
Yes, usually transient and reversible with treatment of underlying cause
Delirium prevalence in hospitalised patients over 65
50% in hospital, 30% in ED, 70–90% in ICU, 88% end-of-life
Mnemonic for causes of delirium
THINK DELIRIUM:
Trauma,
Hypoxia,
Increasing age,
NoF fracture,
smoKer/alcohol withdrawal,
Drugs,
Environment,
Lack of sleep
Imbalanced electrolytes/dehydration/renal failure,
Retention,
Infection,
Uncontrolled pain,
Medical conditions
Drugs that cause delirium
Antidepressants, antipsychotics, benzos, anticholinergics, opiates, steroids, diuretics, recreational drugs
Risk factors for delirium
Age >65, dementia, multimorbidity, male, NOF fracture, infection, visual/hearing impairment, renal impairment
Hyperactive delirium features
Agitation, restlessness, irritability, wandering
Hypoactive delirium features
Quiet, sleepy, inactive, apathetic (most common, often missed)
Other features of delirium
Hallucinations, delusions, fluctuating consciousness
Differential diagnoses of delirium
Dementia, depression, psychosis, drug toxicity, metabolic derangements
Screening and assessment tools in delirium
Confusion Assessment Method (CAM), AMT, MMSE, collateral history
Investigations in confusion screen
FBC, U&E, calcium, TFTs, glucose, B12/folate, cultures, urine dip, CXR, CT head if needed
Core principles of delirium management
Treat underlying cause, reassure, optimise environment, encourage fluids and food, analgesia
Medications used for agitation in delirium
Haloperidol (1st line), lorazepam if Parkinson’s/Lewy body dementia
