Delirium

Exam Cram

• Delirium describes an acutely confused state (acute brain injury) often with multifactorial causes- pain, constipation, urinary retention, sepsis, dehydration and hypoxia particularly in the vulnerable brain (dementia, elderly)

• Presentation: acute fluctuating confusion, 4AT: positive

• Diagnosis: clinical 

• Management: supportive, address multifactorial causes (analgesia, laxatives, catheter, antibiotic, fluids, oxygen, time, re-orientation & stability)

Outline

Background

• Delirium refers to an acute confused state of acute brain failure, similar to AKI or acute hepatitis for the brain

Assessment

History:

• Fluctuating confusion

• Hallucinations

• Vulnerable brain: dementia, previous delirium, elderly + significant brain injury (sepsis, trauma, acute illness)

Examination:

• GCS 14

Investigations

• 4AT: score positive

• Investigate differentials and underlying cause, e.g. sepsis or intracranial event

Diagnosis

Diagnostic criteria: clinical

Differentials: meningoencephalitis, dementia, depression, intracranial event

Management

Holistic

1. Comprehensive Geriatric Assessment (CGA)

2. Pain review & analgesia

3. Bowel monitor & laxatives

4. Bladder scan +- IDC insertion or removal

5. Medication review: opioids, anticholinergic burden, drug burden index, polypharmacy

6. Stable environment, re-orientate, de-escalate

7. Dehydration: PO vs IV fluids

8. Medically unwell- treat underlying cause, commonly antibiotics for infection

Deeper Dive

Prognosis

• Can last 2-6 weeks till 6 months

• Recent debate is that it does increase your risk of dementia

References and Resources

Overview

• Body Systems: Nervous System

• Specialties: Geriatrics > Psychiatry

Page written in 2025.