Delirium

Question 1

What is delirium

Answer 1

Delirium is an acute, fluctuating change in mental status, with inattention, disorganised thinking, and altered levels of consciousness.

Question 2

What are types of delirium?

Answer 2

Hyperactive

Hypoactive

Question 3

What are causes of delirium?

Answer 3

Pain
Infection, esp. UTI
Nutrition and deficiencies e.g. B12
Constipation
Hydration and metabolic imbalances 
Medication
Environment - change

Also: brain tumour, stroke, addison/hyperthyroid crisis, hypoglycaemia

Question 4

What are DDx for delirium?

Answer 4

Hyperactive: alcohol or drug withdrawal, psychosis, dementia

Hypoactive: dementia, stroke

Question 5

What are risk factors for delirium?

Answer 5

• Age >65yrs
  
  • Cognitive impairment
  • Severe Illness
  • Organ failure (chronic lung disease, heart, kidney or liver failure)
  • Sensory impairment
  • Multiple co-morbidities
  • Frailty, malnutrition, immobility
  • Undertreated pain
  • Limb fractures
  • Catheter use
  • Sleep deprivation

Question 6

What 4 things must be present for delirium to be diagnosed?

Answer 6

1. Disturbance in attention
2. Change in cognition
3. Acute/subacute, different from baseline, and fluctuating
4. Evidence of cause e.g. UTI

Question 7

What is Rx for delirium?

Answer 7

Treat and remove any cause

reorientation

avoid sedation

consider haloperidol (not benzodiazepines)

Question 8

What are complications of delirium

Answer 8

Increased morbidity and morality

Increases length of hospital stay.