Delirium Flashcards
(25 cards)
What is delirium?
Disturbance in attention
Change in cognition
Develops over a short period and fluctuates
What percentage of older people experience delirium prior or during hospital admission?
15-60%
What is the onset of delirium?
Sudden (hours/days)
What is the course of delirium?
Short/fluctuating
What is the duration of delirium?
Hours to less than a month
How does hyperactive delirium present?
Agitation
Restless
Hyperactive
How does hypoactive delirium present?
Sleepy
Slow
What are some features of delirium?
Impaired attention Fluctuating alertness Fluctuating emotions Disorganised thinking Distorted perception (hallucinations, illusions, delusions)
What is the pathophysiology of delirium?
Not well understood
Variable derangement of multiple neurotransmitters (ACh)
Direct toxic insults to brain
What are pre-disposing factors?
Advanced age Pre-existing dementia Co-morbidity Post-operative period Terminal illness Sensory impairement Polypharmacy Depression Alcohol dependency Malnutrition
What are precipitating factors?
Opiates + sedatives Hypoxia Low glucose Dehydration Alcohol Infection (chest) UTIs Environmental Catheters (foreign objects) Systemic upset MI Hip fractures Urinary retention Constipation Trimethoprim
What are the hallmark signs of delirium?
Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking
Which delirium is easier to diagnose?
Hyperactive
Hypoactive has twice the mortality rate because of this
What assessments help diagnose delirium?
4AT
CAMS
What does 4AT comprise of?
Alertness
AMT4
Attention
Acute change or fluctuating course
What score indicates delirium using 4AT?
> 4 think delirium
The lower the score the less likely delirium is
What are the 4 features of CAM?
Acute onset and fluctuating course
Inattention
Disorganised thinking
Altered level of consciousness
How is delirium managed?
Identify and treat precipitants
Supportive measures (environment, orientation, sleep)
Assess capacity
Medication
How is delirium treated?
Check hydration Stop nephrotoxic drugs Optimise BP and perfusion Look for intrinsic renal disease Review
Which two drugs should never be prescribed together?
Trimethoprim and Haloperidol!
What side effect does co-codamol cause that contributes to delirium?
Constipation
What side effect does the anti-muscarinic drug tolterodine cause that contributes to delirium?
Confusion
What medication can be used if symptoms do not improve with non-pharmacological interventions?
Haloperidol
Quetiapine
Benzodiazepines
Which delirium drug should be avoided in Parkinson’s disease?
Haloperidol
