Delirium: Difference between revisions

Latest revision as of 11:01, 26 June 2022

An acute brain dysfunction syndrome of fluctuating levels of consciousness
Cardinal features:
- altered mental status and fluctuating course
- inattention
- altered level of consciousness (i.e. RASS not zero) OR disorganized thinking

Drugs
- Iatrogenic
  - Polypharmacy
  - Opioids (too much or too little)
  - Diphenhydramine
  - Benzodiazepines
- Abuse: alcohol
- Poisoning
- Withdrawal
  - Alcohol
  - Benzodiazepine
Infections
- Sepsis
- Pneumonia
- Urinary tract infection
- Skin and soft tissue infection or ulcer
Metabolic
- Endocrine: thyroid, parathyroid, pancreas, pituitary, adrenals
- Electrolytes: sodium, calcium, magnesium, potassium
- Hypoglycemia/hyperglycemia
- Hypoxemia/hypercarbia
- Hypoosmolar/hyperosmolar
- Inborn errors of metabolism: porphyria, Wilson disease
- Nutrition: Wernicke's, B12 deficiency, niacin deficiency
Environmental
- Surroundings, room changes, lack of sunlight indicating day & night
Structures & organs
- CNS
  - Stroke
  - Brain injury
  - Seizure
- Cardiac: heart failure
- Renal: AKI/CKD
- Gastrointestinal: constipation, volvulus
- Genitourinary: urinary retention

Mild
- Elderly: haloperidol 0.5 mg PO/SQ/IV/IM q4h prn
- End-of-life: haloperidol 0.5-1 mg po or subcut daily or BID + haloperidol 0.5-1 mg po/SC q1h prn
Moderate
- Haloperidol 2-2.5 mg po/sc bid or tid + haloperidol 2 mg po/sc q1h prn
- Or methotrimeprazine 5-12.5 mg po/sc bid or tid + prn
Severe
- Elderly: haloperidol 1 mg, or quetiapine 12.5 mg if long QT
- Midazolam 2.5-5 mg sc stat once + haloperidol 5 mg sc stat
- Or methotrimeprazine 25 mg sc stat then po/sc
- Follow with haloperidol 2.5-5 mg sc q30min prn (max 10-15 mg/day)
Sundowning
- Methotrimeprazine qhs
Alternatives

@@ Line 44: / Line 44: @@
 **Endocrine: thyroid, parathyroid, pancreas, pituitary, adrenals
 **Electrolytes: sodium, calcium, magnesium, potassium
-**Hypoglycemia/hyperglycemia
+**[[Hypoglycemia]]/[[hyperglycemia]]
-**Hypoxemia/Hypercarbia
+**[[Hypoxemia]]/[[hypercarbia]]
-**Hypoosmolar/Hyperosmolar
+**Hypoosmolar/hyperosmolar
-**Inborn errors of metabolism: porphyria, Wilson's disease
+**Inborn errors of metabolism: [[porphyria]], [[Wilson disease]]
 **Nutrition: [[Wernicke encephalopathy|Wernicke's]], [[Vitamin B12 deficiency|B12 deficiency]], [[niacin deficiency]]
 *Environmental
-**Surroundings, room changes
+**Surroundings, room changes, lack of sunlight indicating day & night
 *Structures &amp; organs
 **CNS
 ***[[Stroke]]
 ***Brain injury
-***Seizure
+***[[Seizure]]
 **Cardiac: [[heart failure]]
 **Renal: [[AKI]]/[[CKD]]
@@ Line 72: / Line 72: @@
 **Hydration
 *Medications: stop medication
-*Dehydration: IV or hypodermoclesis (fluid given subcutaneously)
+*Dehydration: IV or [[hypodermoclesis]] (fluid given subcutaneously)
-*Hypercalcemia: IV [[bisphosphonate]] ([[zoledronate]]/[[pamidronate]])
+*[[Hypercalcemia]]: IV [[bisphosphonate]] ([[zoledronate]]/[[pamidronate]])
 *Infection: antibiotics
-*Hepatic encepalopathy: [[lactulose]]
+*[[Hepatic encepalopathy]]: [[lactulose]]
 *Brain metastases: [[corticosteroids]] (e.g. [[dexamethasone]])