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Delirium

See Also
1. Altered Level of Consciousness
2. Delirium in Cancer
Definition
1. Acute Confusional State
Risk Factors
1. Age over 60 years
2. Drug or alcohol addiction and withdrawal
3. Prior brain injury (vascular or traumatic injury)
4. Hearing Loss or decreased Visual Acuity
5. Insomnia or other sleep deprivation
6. Polypharmacy
7. Hospitalization or post-surgery
8. Multiple comorbid conditions
9. Poor nutritional status
10. Hepatic failure
11. Chronic Renal Failure
12. Poor nutritional status
Precipitating Factors
1. Infection
2. Dehydration
3. Electrolyte abnormalities
4. Myocardial Infarction
5. Arrhythmia
6. Sleep Deprivation
7. More than 3 medications added within 24 hours
8. Psychoactive medications
Criteria
1. Rapid deterioration in all higher cortical functions
2. Mental status fluctuates widely
3. Short duration of symptoms (Hours to days)
4. Disturbance in both Level of Consciousness and content
5. Autonomic Instability (Abnormal vital signs)
Signs
1. Fluctuating levels of consciousness
  1. Inattention
  2. Perseveration
  3. Decreased alertness
  4. Disorientation
  5. Extremes of activity
    1. Somnolence to agitation
2. Disorganized thought processes (delusions)
3. Memory Impairment (especially short term)
4. Perceptual disturbances
  1. Persecutory delusions are common
  2. Visual hallucinations rare except in organic cause
5. Emotional lability
6. Motor changes
  1. Myoclonus
  2. Asterixis
Course
1. Reversible in over 80% of cases
Evaluation
1. See Confusion Assessment Method
2. See Altered Level of Consciousness (includes labs)
3. Electroencephalogram
  1. Diffuse slow waves
Differential Diagnosis
Prevention
1. Optimize hydration and nutrition
2. Early mobilization of patients
3. Avoid sedatives for sleep (see Sleep Hygiene)
4. Reduce restraints and catheters
5. Reorient patient frequently (involve family presence)
6. Correct vision and hearing
7. Avoid psychoactive medications

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This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:18:28 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.