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Delirium

Delirium. Mini-Lecture June 2013. Objectives. Discuss various causes of delirium Review diagnostic tests in the work-up of delirium. Case.

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Delirium

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  1. Delirium Mini-Lecture June 2013

  2. Objectives • Discuss various causes of delirium • Review diagnostic tests in the work-up of delirium

  3. Case • 75 y/o M with DMII, COPD, and obesity is hospitalized for a hip fracture. Patient was doing well post-operatively with adequate pain management and rehabilitation. On POD #3, he forgets where he is, becomes more lethargic, and refuses to eat. Patient’s temperature is 38.5, HR 105, RR 12, 90% on 2L NC. • What are the possible causes of this change in mental status?

  4. Definition of Delirium • Altered consciousness and cognition with the following characteristics: • Poor attention • Develops over hours to daysand fluctuating course during the day. • Disturbance is likely from medical condition, substance intoxication, or medication side effect. • Unlikely due to preexisting, established, or evolving dementia.

  5. Delirium • 10-20% of all hospitalized adults • 30-40% of elderly hospitalized patients • 60% to 80% of mechanically ventilated ICU patients • 50% to 70% of non-ventilated ICU patients Delirium in older patients, Francis et al., Journal ofthe American Geriatrics Society. 1992;40(8):829 Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. Inouye SK et al., J Gen Intern Med. 1998;13(4):234.

  6. Pointers on Assessment • ABCs and vitals first! Check GCS. • Try to obtain collateral information from family or hospital staff • Get an understanding of patient’s baseline mental status • What were the circumstances around the time of change in mental status? • What is the duration of change? • Has it happened before? • What does the family think is going on?

  7. AEIOU-TIPS mnemonic

  8. AEIOU-TIPS mnemonic

  9. Case • Patient could have multiple causes of his delirium. A few of the possibilities include: • Infection given patient’s temperature and HR (common post-op infections such as UTI and PNA) • Opiate toxicity given RR and O2 sat • Electrolyte imbalance • Hypoglycemia is possible if pt is on insulin and has decreased po intake

  10. Summary • Delirium is common in hospitalized patients and portends a poor prognosis. • Try to obtain collateral information • Use mnemonic AEIOU-TIPS to help determine etiology and useful diagnostic tests

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