A 70 year old female with increasing confusion over 2 days
- 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
- 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