Delirium admission

It is a very common condition in the hospitals. Several things can do this. I found a nice article here.

Some Pearls to remember when dealing with patients with Delirium as per the lecture given at SHM:

1. Work Up: CBC, BMP, UA, CXR, ABG if indicated, EKG and TNT as Coronary Ischemia can cause Delirium

2. Do EEG and LP only if clinically indicated, not for everyone.

3. CT Head if there is head trauma, focal deficits, patient on anticoagulants, or high clinical suspicion of intracranial etiology of delirium

Based on Lecture I heard at SHM annual meeting the management of Delirium involves the following 7 steps from Journal of Gerontology

4.  Treat all possible offending medications first. They are anticholinergics, Antihistamines, Benzodiazepines and Minimize Narcotics (Do not stop narcotics altogether)

5. Treat withdrawal of Alcohol and Benzodiazepines if present

6. Correct Metabolic disturbances like Electrolytes, Glucose and hydration

7. Reduce level of invasion like Foley catheters and lines

8. Assess and treat infection like UTI and Pneumonia

9. Improve environment and mobility

10. Treat pain adequately

11. Non – Pharmacologic measures like (per NEJM)

-eye glasses and adaptive equipment for vision impairment

-Amplifiers and adaptive equipment for hearing impairment

-Orienting communication for Cognitive impairment

-Early mobilization and mobility for Immobility

-Oral Hydration for Dehydration

-Uninterrupted sleep and non pharmacologic aides for sleep deprivation

12. Give LOW DOSE antipsychotics for agitated delirium and stop as soon as possible. Don’t discharge patients on antipsychotics if possible.  EKG monitoring is needed while patient is on Haloperidol. Can use Haloperidol 0.25-0.5mg PO BID. Risperidone, Olanzapine, or Quetiapine can also be used. Avoid Haldol if patient needs to be placed in SNF or rehab as it can delay the discharge.

13. Distraction vest can be used to prevent patient from pulling IV lines

14. Use Benzodiazepines only for alcohol withdrawal not for delirium