Delirium: Difference between revisions
(→DDX) |
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#?CT/LP | #?CT/LP | ||
== | == Differential Diagnosis== | ||
#A | #A | ||
##Alcohol | ##Alcohol | ||
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##[[Seizure]] | ##[[Seizure]] | ||
##[[Stroke]] | ##[[Stroke]] | ||
{{Psych DDX}} | |||
== Treatment == | == Treatment == |
Revision as of 23:42, 15 February 2015
Background
Delirium vs. dementia vs. psych
Clinical Features
- Main cognitive impairment is that of inattention (vs memory in dementia)
- Generally develops over hours to days
- Symptoms are classically described as fluctuating throughout the day (ie may appear normal in between episodes)
ED Confusion Assessment Method
- Acute onset of mental status changes and/or fluctuating course
- Anattention
- Disorganized thinking
- Altered level of consciousness
A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria
Workup
Main goal is to find the underlying cause.
- CBC (eg elevated WBC)
- U/E/Cr (eg electrolyte derangements)
- LFTs (eg hepatobiliary infection)
- Urine analysis (eg UTI)
- CXR (eg pneumonia)
- ?Utox
- ?CT/LP
Differential Diagnosis
- A
- Alcohol
- E
- Electrolyte Abnormalities
- Encephalopathy (hepatic, hypertensive)
- I
- Insulin (hypoglycemia)
- O
- Opiates
- U
- Uremia
- T
- Trauma
- Toxic Exposure
- Thyrotoxicosis
- I
- Infection
- P
- Psych
- S
General Psychiatric
- Organic causes
- Psychiatric causes
Treatment
- Treat underlying cause
- Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features