Definition
Acute confusional state arising secondary to a physical cause.
Causes
- Infection
- Medications
- Alcohol
- Hypoglycaemia
- Pain
- Nutritional deficiencies
- Head injury
- Triggered or exacerbated by environmental factors (e.g. unfamiliar surroundings, hospitalisation)
Advanced age, multiple comorbidities, underlying cognitive impairment and a previous history of delirium are all risk factors for delirium
On Primary Survey
- A:
- B: Signs of pneumonia, disordered breathing (stroke)
- C: Tachycardia, hypotension (features of dehydration)
- D: Blood glucose, GCS/AVPU, pupils
- E: Signs of liver failure, alcohol abuse, infection
Hyperactive delirium: agitation, restlessness, hallucinations and delusions
Hypoactive delirium: drowsy, stuporous
Investigations
- Bedside: glucose, ABG, ECG, urine dipstick and MSU
- Bloods: FBC, U&E, LFTs, TFT, bone profile, blood cultures (if features of infection)
- Imaging: CXR, CT brain
Management
- Treat the cause
- Reduce distress and prevent accidents (encourage family to sit with patient)
- Nurse in moderately lit quiet room with familiar staff members
- Attend to any physical limitations (e.g. hearing aids, visual aids)
- Minimise medication that might contribute to delirium
- Ensure a clock is nearby to help orientation
- Consider behaviour chart if the patient is being aggressive
- Sedatives
- Only used if the patient is posing a risk to themselves or others
- Olanzipine or Risperidone are usually used
- NOTE: avoid haloperidol in patients with a background of Parkinson’s disease or Lewy Body dementia
- Use Quetiapine in these patients