Delirium
What is it?
Acute confusional state
Inattention
Can't focus
- Altered cognition
- Rapid onset medical illness
- Psychomotor actvity
- Hyperactive
- Hypoactive
- Fidgetting
Primary causes of confusion
Infection 40%
- Urinary Tract Sepsis,
LRTI, Skin, Biliary Sepsis
Drugs 20%
Neurological 10%
Dehydration 5%
Fever - Sepsis - WCC - Elderly NOT Typical
Fever
- Fever is mediated by IL-1, TNF-alpha.
- These “pyrogens” stimulate hypothalamus.
- Increases the temperature set point.
- The body then meets that new set point.
This may not happen in older people
↑WCC
Leukocytosis you need:
- A reactive, well working bone marrow
- Quick acting inflamm mediators
- A reserve of precursor cells for release from marrow
This may not happen in older people
Clinical approach
- ABCs
- Remember the principal causes above
- If in doubt treat for sepsis
- Note Motor Activity
- Restless
- Drowsy
- Figetting
- Attention span?
- Perceptual disturbances
- PHONE THE RELATIVE
Note
- Appearance
- Behaviour
- Speech and attitude
- Disorders of thought
- Disorders of perception
- Mood and affect
- Insight and judgement
- Sensorium and intelligence
Management tips
- ABC (particularly hypoxia)
- DEFG (e.g. hyperglycaemia, DKA or hypoglycaemia)
- If in doubt: cultures and treat for sepsis (resp, UTI, biliary, skin) {antibiotic guidelines here}
- Actively seek/treat dehydration
- Think toxicology (particularly alcohol/withdrawal)
- Pabrinex in all (e.g. ↓Na+, ↑Ca++)
- Consider CT brain after admission to hospital
- Firm calm communication, constant reorientation, have a realtive present
- If sedation required and safe, use Benzos +/- Haloperidol in preference to Respiridone, Olanzapine or Quetiapine
