A 70 year old female with increasing confusion over 2 days

1. Causes of delirium:

Common causes in cancer patients in bold

Pain

Metabolic

electrolytes – Ca, Na 

acid base disorders incl. hypoxia, hypercarbia

hypoglycaemia

uraemia/ renal failure

Infection

Fever

Reduced cardiac output

dehydration

blood loss/ anaemia

IHD, CCF

CNS

CVA/ TIA/ ICH

Metastatic disease

Medication/ Drugs

medication incl excess analgesics

alcohol, drug use

Environmental

hypo/ hyper thermia

Behavioural/ Psychiatric

new surroundings

acute psychosis

Other

Faecal impaction

urinary retention

1. Approach to the patient:

Differentiate acute delirium from dementia

Assume acute confusion is a delirium until proven otherwise

Attend to immediate life threats

Investigate and treat reversible causes