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Delirium (sometimes called 'acute confusional state') is an acute,…
Delirium (sometimes called 'acute confusional state') is an acute, fluctuating syndrome of inattention, impaired level of consciousness, and disturbed cognition.
Classes
Hyperactive delirium can present with inappropriate behaviour, hallucinations, or agitation.
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Factors
Predisposing
Older age (over 65 years), Cognitive impairment (such as dementia).
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Iatrogenic events (such as bladder catheterization, polypharmacy, or surgery).
History of, or current, alcohol excess.
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Precipitating
Infection such as urinary tract infection, infected pressure sore, or pneumonia.
Metabolic disturbance such as hypoglycaemia, hyperglycaemia (including advanced carcinomatosis), or electrolyte abnormalities (including that due to dehydration).
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Respiratory disorders such as pulmonary embolism or exacerbation of chronic obstructive pulmonary disease.
Neurological disorders such as stroke, encephalitis, or subdural haematoma.
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Gastrointestinal disorders such as hepatic failure, constipation (including faecal impaction), or malnutrition.
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Complications
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Distress for the person, their family, and/or carers.
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DDx
Physical illness e.g thyroid disease, charles bonnet syndrome, temporal lobe epilepsy
Mental illness e.g. depression, dementia, anxiety
Management
Hospital admission urgent assessment, close monitoring and treatment
where admission is not apt -arrange targeted investigations based on findings from the history and examination e.g urine, bloods, sputum specimen
Primary care- refer to elderly care consultant/psychiatrist if doubt with diagnosis, severe agitation or distress , detention required
Signs & Symptoms
Behavioural changes- acutely over hours and days, altered cognitive function, inattention, disorganised thinking, altered perception, altered physical function, social behaviour and level of consciousness
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