Delirium

Background

Delirium vs. dementia vs. psych

Clinical Features

1. Impairment of arousal and content of consciousness
2. Generally develops over days
3. Symptoms may be intermittent and vary in severity

ED Confusion Assessment Method

1. acute onset of mental status changes or fluctuating course
2. inattention
3. disorganized thinking
4. altered level of consciousness

A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria

Workup

1. CBC
2. Chemistry
3. LFTs
4. UA
5. CXR
6. ?Utox
7. ?CT/LP

DDX

1. A
   1. Alcohol
2. E
   1. Electrolyte Abnormalities
   2. Encephalopathy (hepatic, hypertensive)
3. I
   1. Insulin (hypoglycemia)
4. O
   1. Opiates
5. U
   1. Uremia
6. T
   1. Trauma
   2. Toxic Exposure
   3. Thyrotoxicosis
7. I
   1. Infection
      1. PNA, UTI, meningitis/encephalitis, sepsis
8. P
   1. Psych
9. S
   1. Seizure
   2. Stroke

Treatment

• Treat underlying cause

See Also

• Altered Mental Status