Evaluation Of the Patient with Delirium

The appropriate evaluation of the patient with delirium includes which of the following?
A) Evaluation of metabolic causes such as electrolytes and glucose.
B) Evaluation for infection such as UTI and pneumonia.
C) Evaluation of a patient’s medications.
D) Evaluation of oxygen saturation.
E) All of the above.

Discussion
The correct answer is
“E.”
Causes of delirium are many often acting together in a multifactorial manner, and are best considered by a systematic approach.
Metabolic causes include electrolyte disturbances (don’t forget calcium), hypoglycemia, and hypoxia. Numerous infections may lead to delirium.
Neurologic causes include head trauma, meningitis, and vasculitis.
Many medications cause delirium, including anticholinergics, antidepressants, sedative– hypnotics, and steroids.
Dehydration and prerenal azotemia may lead to delirium.
Alcohol intoxication or withdrawal may precipitate delirium as well

CAUSES OF DELIRIUM, “WHHHHIMP” MNEMONIC

• Wernicke encephalopathy
• Hypoperfusion
• Hypoglycemia
• Hypertensive encephalopathy
• Hypoxia
• Infection or intracranial bleed
• Meningitis or encephalitis
• Poisons or medications