Delirium
why is this sepaarte from 'acute confusion.'
| Headline | |
|---|---|
| History | Risk factors: age>65, # hip, underlying cognitive impairment, infection, anticholinergic drugs ➥ Signs of infection? ➥ Baseline cognition (MMSE/ACE-R/AMTS?) → screen with 4AT ➥ Changes to medication? Non-prescription meds, illicit and herbal drugs, anticholinergic drugs; alcohol (withdrawal or intoxication) ➥ Co-morbidities especially neuro, cardio, metabolic; hypoxia? ➥ Pain? ➥ Bladder and bowel? ➥ Environmental factors? Sleep? Any physical aggression? |
| Examination | hyperactive - looking around room, plucking at bedclothes, agitation, wandering etc. ➥ hypoactive - drowsiness/inattention, ↓ mobility, ↓ ability to care for self ➥ hallucinations (visual/auditory), disorientation ➥ fluctuating function |
| Diagnostic investigations | COLLATERAL... Bloods: FBC (infection, anaemia); U&Es (metabolic disturbances, hepatic encephalopathy), haematinics, TFTs (as cause for dementia) ➥ Bladder scan, urine MC+S ➥ Abdo XR: constipation? other causes of pain? ➥ Drug levels in patients on digoxin, lithium; alcohol if suspect intoxication/withdrawal ➥ CXR: pneumonia, congestive heart failure ➥ ECG: myocardial infarction? arrhythmia? ➥ ABG: ↓ O2, ↑ CO2, lactate? |
| Differentials | Are these ddx or actually underlying causes???? Encephalopathy or delirium??????? |
| Immediate management | Correct organic + reversible causes - i.e. infection, retention, constipation, electrolytes ➥ Behaviour chart. Behavioural: reassurance, reorientation; reduce sensory overstimulation, correct sleep-wake reversal ➥ May involve antipsychotics - olanzapine or risperidone. Need MHLT input? ➥ Sedation as last resort, if unable to keep patient safe ➥ Associated with increased mortality! |
| Ongoing management | ➥ Dietician input - parenteral feeding suitable? ➥ Can take weeks-months to fully resolve Associated with ↑ risk dementia in the future? |