Delirium Flashcards
What is delirium and why is it important to identify?
An acute confusional state assosciated with a 35-40% risk of death in following year.
Signs of delirium?
Distrubance in attention
Change in cognition eg memory, language disturbance, perceptual disturbance
What are the two types of delirium?
Hyperactive
Hypoactive
Can have a mix
What is the pathophyisology?
Thought to be derangement of neurotransmitters, direct toxic insults to brain e.g. drugs, hypoxia, low Na, low glucose and aberrent stress responses by body eg cortisol, prostaglandins, cytokine release
Predisposing factors?
Age, Pre-existing dementia, Co morbidity, post op period, terminal illness, depression, alcohol dependancy, malnutrition, polypharmacy
What is delirium tremens?
Delirium cause by alcohol withdrawals
How can delirium be assessed?
- 4AT
- Confusion assesment method (CAM
Features of hyperactive delirium?
Agitation, aggression, wandering
Features of hypoactive delirium?
Withdrawn, apathetic, sleepy, coma
Which delirium is most dangerous?
Hypoactive, 2x mortality rate
Which is the first line medication in agitated patients with delirium?
Haloperidol (Not in Parkinsons as worsens symptoms)
Use Quetiapine instead
Which medication is used in patients who are seizing or having alcohol/benzodiazepene withdrawal?
Lorazepam, however can worsen delirium
