Delirium

Background

Delirium vs. dementia vs. psych

Clinical Features

1. Main cognitive impairment is that of inattention (vs memory in dementia)
2. Generally develops over hours to days
3. Symptoms are classically described as fluctuating throughout the day (ie may appear normal in between episodes)

ED Confusion Assessment Method

1. Acute onset of mental status changes and/or fluctuating course
2. Anattention
3. Disorganized thinking
4. 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.

1. CBC (eg elevated WBC)
2. U/E/Cr (eg electrolyte derangements)
3. LFTs (eg hepatobiliary infection)
4. Urine analysis (eg UTI)
5. CXR (eg pneumonia)
6. ?Utox
7. ?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
    • PNA, UTI, meningitis/encephalitis, sepsis
• P
  • Psych
• S
  • Seizure
  • Stroke

General Psychiatric

• Organic causes
  • Delirium
  • Dementia
  • Overdose
• Psychiatric causes
  • Depression
  • Anxiety
  • Conversion disorder
  • Bipolar disorder
  • Acute psychosis
  • Panic attack
  • Schizophrenia

Treatment

• Treat underlying cause
• Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features

See Also

• Altered Mental Status