Delirium

RFs: age > 65, male, impaired hearing or vision, prior hx delirium, dementia, hospitalization, surgery or serious illness, multiple meds, baseline dementia; Sx: acute change from prior behavior, including→ disorganized thinking, impaired short term memory, inattention, disorientation, confusion, delusions, hallucinations, altered sleep patterns; hypoactive (75%) or hyperactive (25%); Sx fluctuate; Spectrum from somnolent to very agitated; Typically reversible. Delirium is always secondary to something, including:

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Delirium

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Diagnosis

Delirium: Etiologies By Organ System

Toxidromes And Toxins

Other Diagnoses

Pulmonary process: Hypoxemia, hypercarbia, pneumonia, pulmonary embolism

Cardiac process: Heart failure, heart attack, hypotension, hypertensive encephalopathy

GI process: Bleeding, hepatic encephalopathy

Renal process: Uremia, hypovolemia

Heme-Oncology: Malignancy, including para-neoplastic syndromes, anemia

Infectious process: Infection anywhere; the more frail the patient, the lower magnitude the infxn necessary to cause delirium

Endocrine/Metabolic process: Hyper/hyponatremia, Hypercalcemia, Hyper/hypoglycemia, Hypo/hyperthyroidism, Vitamin B1 deficiency (Wernickes encephalopathy)

CNS process: stroke, infection, Wernickes, non-convulsive status, trauma, autoimmune/inflammatory, other

Multi-system organ dysfunction can contribute

Substances of abuse: Cocaine, crystal meth, amphetamines, PCP, ETOH, canabis, other

Toxic exposures: Carbon monoxide, organophosphates, others

Meds: ADHD meds, dopaminergics, SSRIs, steroids, benzos, narcotics, dilantin, other - try to link new med to onset of sx

Withdrawal from alcohol, benzos, narcotics, other combinations of agents

Pain: Severe pain, in particular if coupled w/any of above

Unfavorable environments: Hospitalization, disruption of normal sleep wake cycle, ICU stay, procedures, restraints, foley catheter

Delirium

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