Tuesday, January 12, 2010

January 7th - LBJ - Delirium

How do you Diagnose Delirium? With the CAM:
A - Acute Onset and Fluctuating Course
B - Inattention
C - Disorganized thought (rambling speech, changing subjects)
D - Altered Consciousness (from stupor to hyperalert)
(To diagnose Delirium you need A and B plus C or D) 

How to differentiate from dementia - Essentially more insidious onset, and patients with dementia usually have normal consciousness. 

Risk Factors:  Increasing Age, previous history of delirium or cognitive impairment, underlying pain, high dose of pain meds, underlying chronic diseases (i.e. malignancy) 

Causes:  You name it and it can cause delirium...
I WATCH DEATH is a good mnemonic, but there are many out there:

Infection (UTI, PNA are common, but any cause possible)
Withdrawal (of EtOH or other drugs)
Acute metabolic (renal failure, liver failure, glucose)
CNS pathology (you name it, it's here)
Hypoxia (any cause - Embolism, infection, anemia)
Deficiencies (electrolytes)
Endocrinopathies (esp Glucose, Thyroid)
Acute vascular diseases (MI, CVA)
Toxins or drugs (This list is endless - offenders include benzos, quinolones, narcotics, steroids)
Heavy metals

Other Issues That can cause this - HTN, post-op state, seizures, fecal impation and many others....
1) Prevention - Frequent reorientation and stimulation (i.e. Lights on during the day/sitter).  Maintain the sleep-wake cycle in patients, make sure they can hear well and see well, make sure they get good hydration and nutrition, and don't restrain them ig you can (this includes foleys & SCD/TEDS)
2) Treat the underlying condition (i.e. infection, offending medication, pain)
3) Haloperidol and other antipsychotics may be needed, especially in the post-op state

No comments: