Disease - Delirium

From CambridgeNotes

Delirium = Acute confusional state

History and Examination

  • Acute onset
  • Fluctuating conscious level (often worse at night)
  • Disordered perception
  • Motor changes e.g. increased activity, purposelessness, wandering
  • Autonomic changes e.g. sweating, tachycardia, pupil dilatation
  • Ineffective thinking e.g. delusions are common
  • Mood changes e.g. lability, apathy, perplexity, depression
  • Look for evidence of an underlying cause e.g. infection, trauma, focal neurology

Differential Diagnosis

  • Extremes of age
  • Diffuse brain disease e.g. dementia or Parkinson's disease
  • Cholinergic deficit e.g. taking TCAs
  • Precipitants - think through aetiological sieve
    • Infections: urinary tract infection, chest infection
    • Toxic: alcohol, drugs
    • Metabolic: hypoxia, electrolyte imbalance, endocrine conditions
    • Other

Investigations

  • Informant history (need to know pre-morbid function level)
  • Cognitive Assessment
  • MSU, ECG
  • Bloods: FBC, ESR, U&E, Glucose, LFTs, TFTs, Calcium
  • Imaging: chest X-ray, CT, MRI as directed by history and examination

Treatment

  • Rehydrate and correct electrolyte abnormalities
  • Treat underlying cause if possible
  • Facilitate orientation e.g. quiet, well lit room
  • Avoid conflict
  • Tranquilize sparingly e.g. Haloperidol 3-20mg
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