Delirium

Background

  • Also known as "acute toxic-metabolic encephalopathy"
  • 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[1]

  • 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

Differential Diagnosis

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma

Psychiatric

General Psychiatric

Evaluation

Main goal is to find the underlying cause

AMS Workup

Common Orders

Consider Based on Clinical Situation

  • Blood and urine cultures
  • Ammonia level
  • Tylenol/Aspirin level
  • LP
  • Serum Osm
  • Coags
  • Cortisol
  • ABG/VBG
  • CO level

Management

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

Disposition

  • Admission

See Also

References

  1. Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941.