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DELIRIUM

SUAIDA 09020073

DEFINITION
Delirium is a disturbance of consciousness (awareness of the persons environment) characterized by altered or shifting mental status and inattention (reduced ability to focus, sustain, or shift attention). There are also changes in cognition (basic mental functions) such as memory impairment, disorientation to time or place, and language disturbance. There also may be disturbances of perception (accurate appreciation of the environment) such as hallucinations (seeing or hearing things that are not actually there), abnormal speech, abnormal movements (including tremors or picking at clothing), disruptive or violent behavior, and sudden shifts in emotions.

What are the causes of delirium?

V (vascular): stroke (infarct or hemorrhage causing a sensory aphasia), I (infectious): herpes simplex encephalitis or other viral encephalitis; bacterial, T (traumatic): open or closed head trauma, acute or chronic subdural hematoma A (autoimmune): systemic lupus erythematosus (SLE), multiple sclerosis
M (metabolic/toxic): hypo- or hyperglycemia, hyponatremia, hypercalcemia,

I (iatrogenic): drug toxicity (particularly in the elderly): psychotropic drugs, N (neoplastic): primary brain tumor, metastatic brain disease S (seizure): postictal state, nonconvulsive status epilepticus (rare) Other (psychiatric): bipolar disorder/mania, psychosis

SYMPTOMS
Diagnosis of delirium according to the International Classification of Diseases-10th edition (ICD10)requires symptoms in each of the following areas:
Impairment of consciousness and attention; Global disturbance of cognition (including illusions, hallucinations, delusions and disorientation); Psychomotor disturbances; Disturbance of the sleep-wake cycle; Emotional disturbances

DIFFERENTIAL DIAGNOSE
Dementia Psychotic disturbance Schyphrenia Mood disturbance

MANAGEMENT
1.

Treatment of agitation

Treatment of delirium depends on the correct identification of the underlying condition. If agitation or combativeness is likely to interfere with the investigation or if there is physical threat to the patient or to the staff, the best medications to use are butyrophenones (e.g., haloperidol), group 3 phenothiazines (e.g., trifluoperazine), or benzodiazepines. Haldol 2 to 10 mg intramuscularly (IM) may be expected to reach peak serum levels in 20 to 40 minutes. Repeati

2. The following blood tests should be ordered immediately:


Complete blood count (CBC) with differential Electrolyte panel, including stat glucose Full chemistry panel, including liver function tests Urine toxicology screen (if drug intoxication is suspected) Urine and blood cultures (if fever is present) Arterial blood gas Calcium, phosphate A chest x-ray should be obtained if fever or dyspnea is present. Erythrocyte sedimentation rate may be measured, but its specificity is low.

PROGNOSE
Delirium is a negative prognostic indicator in hospitalized patients, often leading to longer hospital stays and higher mortality. Preventing delirium is the most effective strategy for reducing its frequency and complications.