Delirium Flashcards
Onset - sudden/gradual?
Sudden
Pathophysiology
Derangement of multiple neurotransmitters
Direct toxic insult to brain
- hypoxia, medications
Body’s abnormal stress response
Clinical presentation
Sudden confusion Change in cognition Fluctuating course Mood change Agitation Inattention Drowsy Hallucinations (visual) Delusions Impatient of consciousness Disturbance of sleep-wake cycle
Types (2)
Hypoactive
Hyperactive
Hypoactive delirium features
Patient suddenly becomes quiet Withdrawn Sleepy Slow Unmotivated
Hypoactive/Hyperactive are more likely to go un-noticed ?
Why ?
Hypoactive
- the patient is quiet
Hyperactive delirium features
Agitation
Restless
Aggressive
Wandering
Causes (trigger factors)
Infections Medication / polypharmacy Intoxicating substances Dehydration Changed environment Hypoxia Low glucose
Which medications are most likely to cause delirium?
Strong pain killers
Which group of hospitalised patients are more likely to get delirium?
Hip fracture patients
Who gets delirium (predisposition)
Pre-existing dementia Old age Underlying co-morbidity Terminally ill Hospitalised patient Polypharmacy patient Depressed patient Malnourished patient
Hallmarks of delirium
Acute and fluctuating
Inattention
Altered consciousness
Disorganised thinking
Management - use pharmacological / non-pharmacological measures where possible ?
NON-pharmacological measures are preferred
Management
Review current medication
Identify and reverse all underlying causes
Supportive environment
Diet and hydration
Management - medication
Medication is not routinely used to treat delirium
Haloperidol
- combats agitation
Quetapine
