Diagnosis
Definition: Delirium vs. dementia.
Diagnosis is made clinically using the Confusion Assessment Method (CAM).
The first step in the diagnosis delirium is to r/o underlying medical causes.
H&P performed.
Meds reviewed.
No focal or lateralized neurologic findings.
Common presentation:
Risk Factors:
Red flags:
Questions for diagnosing Delirium.
Ddx and causes.
Dx studies:
-CMP (electrolytes, creatinine, glucose, calcium, LFTs), CBC w/ diff, UA and Urine culture. Consider other studies to find source of infection if suspected.
-ABG, drug levels, and toxicology screen if above labs don’t reveal cause.
-CT head if no obvious cause of delirium is found on first eval.
-Will keep LP (meningitis) and EEG (seizures) in mind.
Early recognition and treatment of delirium may shorten its duration.
Treatment
The first step in the management of delirium is to determine and treat underlying medical causes.
D/C benzodiazepines & sedative hypnotics (like zolpidem)- even in low doses have been shown to cause or worsen delirium.
D/C Anticholinergics (may cause or worsen delirium),
D/C most psychotropic medications
Evaluate for urinary retention, UTI
Nonpharmacologic treatment and prevention.
Pharmacotherapy.
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In surgical patients or other patients with pain that have delirium, pain management is an important part of managing delirium.
Imaging modalities are not helpful in the absence of localizing signs.
Important Delirium Links
- The difference between lethargy, obtunded, stupor, and coma.
- Tests for Acute vs. Chronic Cognitive Changes.
- Delirium resources.
- Opioids can affect mental status. However, if a patient with delirium has pain, opioids should be used (if indicated) to treat pain. Untreated pain itself is associated with delirium.
Further Reading
Am Fam Physician. 2014 Aug 1;90(3):150-158. Delirium in Older Persons: Evaluation and Management. https://www.aafp.org/afp/2014/0801/p150.html