SHM's Clinical Quick Talks-Delirium

Pdf Summary

The document, authored by Dr. Himabindu Lanka, provides a detailed overview of delirium, an acute disorder characterized by altered awareness and fluctuating attention. Delirium, also known as acute confusional state, can manifest as hyperactive (agitated), hypoactive (apathetic and withdrawn), or mixed types. Recognizing these manifestations is critical, especially since hypoactive delirium is more common but often missed.<br /><br />Key risk factors include age, gender (male), sensory impairment, dementia, depression, and other multiple medical conditions. Acute factors such as certain medications, surgery, and pain management issues also contribute to the onset of delirium. The pathophysiology involves tissue hypoxia, inflammation, oxidative stress, leading to hypo-cholinergic and hyper-dopaminergic states in the brain.<br /><br />The document uses the mnemonic "DELIRIUM" to summarize the primary causes: Drugs, Electrolyte abnormalities, Lack of drugs like sedatives or alcohol, Infections, Reduced sensory input, Intracranial issues, Urinary or fecal incontinence, and Myocardial/pulmonary causes.<br /><br />Differentiating delirium from dementia, depression, and acute psychiatric syndromes is challenging due to overlapping symptoms. Detailed history taking and input from caregivers are essential for accurate diagnosis.<br /><br />Treatment approaches are categorized into non-pharmacological and pharmacological methods. Non-pharmacological strategies emphasize orientation aids (clocks, calendars), maintaining a feeling of safety, and using sensory aids such as eyeglasses and hearing aids while avoiding restraints. Pharmacological treatments often involve antipsychotics like Risperidone, Olanzapine, Quetiapine, and Haloperidol, but these should be used cautiously due to potential adverse effects and high mortality risks, particularly in elderly patients with possible undiagnosed dementia.<br /><br />Crucial clinical tips include recognizing the high incidence and frequently underdiagnosed nature of delirium, prioritizing non-pharmacological treatments, and understanding the value of reorienting communication and sensory aids.<br /><br />This summary serves as a script for managing elderly patients at risk for delirium, supported by high-value resources and studies like the AID-ICU trial and reviews from reputable journals and medical resources.

Asset Subtitle

Himabindu Lanka

Keywords

delirium

acute confusional state

Dr. Himabindu Lanka

risk factors

non-pharmacological treatments

pharmacological treatments

hypoactive delirium

pathophysiology

DELIRIUM mnemonic

differential diagnosis