Delirium: Difference between revisions
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== Differential Diagnosis== | == Differential Diagnosis== | ||
*A | |||
**Alcohol | |||
*E | |||
**[[Electrolyte Abnormalities]] | |||
**Encephalopathy (hepatic, hypertensive) | |||
*I | |||
**Insulin ([[hypoglycemia]]) | |||
*O | |||
**Opiates | |||
*U | |||
**Uremia | |||
*T | |||
**Trauma | |||
**[[Toxic Exposure]] | |||
**[[Thyrotoxicosis]] | |||
*I | |||
**Infection | |||
***[[PNA]], [[UTI]], [[meningitis]]/[[encephalitis]], [[sepsis]] | |||
*P | |||
**Psych | |||
*S | |||
**[[Seizure]] | |||
**[[Stroke]] | |||
{{Psych DDX}} | {{Psych DDX}} |
Revision as of 23:43, 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