Delerium

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Features

-  Acute confusional state of transient & usually reversible global disorder of cognition

-  Meidcal emergency

-  Increased mortality & morbidity

-  Syndrome of multiple casues w wide range of neuropsychiatric abnormalities

-  Suspect in pts w depression, dementia or elderly who present w acute deterioration

 

Associated S/S

-  Decreasd attention span

-  Waxing & waning confusion, clouding of consciousness

-  Disorientation

-  Thought disorder, abnormal behaviour, violence, illusions, hallucinations, delusions

 

Subtypes of Arousal

-  Hyperactive

-  EtOH withdrawal, PCP/amphet/LSD intoxication

-  Hypoactice

-  Heaptic encephalopathy, hypercapnia

-  Mixed

-  Day time sedation w nocturnal aggitation

 

DSM IV

-  Disturbance of consciousness w decreased ability to foucs, sustain or shift attention

-  Change in cognition not better explained by pre-existing, established or evolving dementia

-  Disturbance develops over short period & tends to fluctuate during the course of a day

-  Evidence from Hx, PE & Ix indicate disturbance caused by medical condition, intoxication, medication or multiple factors

 

Causes

-  16% no cause found

-  Metabolic abnormalities

-  Hypoglycaemia

-  B12, Thiamine, Folate deficiency

-  Structural brain lesions, post-op

-  Hypoxia, hyperthermia

-  Anticholinergics

-  PCP/amphet/LSD intox

-  EtOH/sedative withdrawal

-  Infection: UTI, URTI, Pneumonia, CNS, septicaemia

 

DDx

-  Dementia, depression, mania (Bipolar), schizophrenia

 

Ix

-  MSE (MMSE), Vitals

-  WBC: infection

-  ESR: increase: infection

-  U&E: CRF, ARF

-  BSL: hypoglycaemia

-  LFTs: hepatic encephalopathy

-  Tox screen

-  Thiamine, B12, Folate levels: EtOH

-  Septic Workup

-  Urinalysis: UTI

-  CXR: Pneumonia

-  CT – Brain: structural lesions, CNS infection

 

Mx

-  Dx & Mx underlying cause

-  Fluids & nutrition

-  Environemntal modification

-  Psych & medical review

-  Rx if risk of injury

-  Acute behavioural management