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Delirium

Delirium is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Delirium is a clinical syndrome characterized by acute changes in awareness, cognition, and perception with a waxing and waning course.
  • Delirium is a syndrome secondary to an underlying medical condition.
  • Pathophysiology unknown:
    • Diffuse cerebral dysfunction
    • Derangements of cerebral acetylcholine
    • CNS dopamine, γ-aminobutyric acid, and serotonin may be involved.
  • Frequently missed by emergency medicine physicians due to atypical chief complaints.
  • Associated with increased mortality for inpatients and increased length of stay.

Etiology

  • Neurologic:
    • Meningitis or encephalitis
    • Seizure
    • Wernicke encephalopathy
    • Hypoxia and hypoperfusion of the brain
    • Intracranial bleed or mass
  • Pulmonary:
    • Pneumonia
    • Other pulmonary etiology of hypoxia
  • Cardiovascular:
    • Hypertensive crisis
    • Acute coronary syndromes
    • Arrhythmia
  • GI:
    • Hepatic encephalopathy
    • Dehydration
  • Renal:
    • UTI
    • Acute renal failure
  • Endocrine:
    • Hypoglycemia
    • Hyperglycemia
    • Hypothyroid
  • Rheumatologic:
    • Collagen vascular disorder
  • Toxicologic:
    • Environmental toxins
    • Medications
    • Withdrawal from barbiturates or alcohol
  • Other:
    • Electrolyte abnormalities
    • Vitamin deficiencies
    • Hypothermia
    • Hyperthermia
    • Trauma

Geriatric Considerations
  • Common presentation in older ED patients
  • Up to 10% of older ED patients may have delirium.
  • Many patients will present with subtle symptoms and vague chief complaints:
    • Fall, dizzy, or not feeling well
  • Waxing and waning symptoms
  • Cause may be life-threatening condition.

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Citation

Rosen, Peter, et al., editors. "Delirium." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307250/all/Delirium.
Delirium. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307250/all/Delirium. Accessed April 25, 2019.
Delirium. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307250/all/Delirium
Delirium [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307250/all/Delirium.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Delirium ID - 307250 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307250/all/Delirium PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -