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DELIRIUM

      ETIOLOGY &
PREDISPOSING FACTORS
   INVESTIGATION &
      TREATMENT
ETIOLOGY
• A) Metabolic disorders -

   Hypoglycemia,
   Hypoxia,
   Fluid & electrolyte disturbances,
   Dehydration
   Disturbances of Ca, Mg.
 Hyponatremia.
 Liver & kidney failure.
 Endocrinopathies (thyroid,
  parathyroid, pituitary),
 Porphyria
 Thiamine def.
B) Drug related


•   Sedative-hypnotics.
•   Anticholinergics
•   Antihistaminic drugs.
•   Psychotropics.
•   Anticonvulsants.
•   Narcotic analgesics.
•   Withdrawal syndromes.
•   Delirium tremens.
• c) Infections
   Meningitis.
   Encephalitis,
   Brain abscess,
   Pneumonia
   Lyme disease.
    AIDS
    Septicemia
• D) Neurological


   Strokes,
   Epilepsy,-postictal
   Head injury,
   Hypertensive encephalopathy,
   Brain tumors,
• E) Postoperative

    Specific surgeries.
    anesthetic and other drug effects,
    Electrolyte imbalances.
    hypoxia and anemia,
    fragmented sleep,
    pain
• F) Miscellaneous
 Anemia
 Cerebral vasculitides.
 Paraneoplastic and limbic encephalitis.
 Trauma.

 Dehydration.

 Electrocution.
 attempted hanging
Predisposing factors
Advanced age.
Dementia.
Fluid and electrolyte disturbances
dehydration
Other metabolic disturbance.
 hepatic insufficiency.
contd..

cancer
Infections.
AIDS.
Malnutrition.
Cardiorespiratory failure.
Prior stroke.
contd…

Polypharmacy and use of analgesics,
 psychoactive drugs, or anticholinergics.

Drug abuse, alcohol or sedative
 dependency.

Sleep disturbance.
 Fever, hypothermia
Physical trauma or severe burns
Fractures
Male gender
Depression
Investigations
• Blood cell count
• Blood glucose
• Blood-urea, nitrogen, creatinine,
  transaminase,ammonia levels.
• Thyroid fn tests.
• Chest x-rays
• EEG changes
contd…
•   Arterial blood gas studies
•   ECG
•   Urine analysis.
•   Lumbar puncture
•   Neuroimaging
MANAGEMENT
I. finding the cause and
   eliminating it

• with symptomatic measures involving
  attention to fluid and electrolyte balance,
  nutritional status, and early treatment of
  infections.
II. environmental
               interventions
• . Reduce unfamiliarity by providing a
 calendar, a clock, family pictures, and
 personal objects.

• Maintain a moderate sensory balance in the
  patient by avoiding sensory overstimulation
  or deprivation.
• Other environmental measures
   :- include providing soft music and
  warm baths, and allowing the patient to
  take walks when possible.

•   Proper communication and support.
• It is best to avoid the use of drugs in
  confused patients because their effects
  further cloud the clinical picture and
  may worsen the delirium.
• MEDICATION is necessary if the
  patient’s behavior is potentially
  dangerous, interferes with medical care.

• Haloperidol (starting at 0.25 mg
  daily) repeated every 30 minutes,
  given (PO) or (IM), up to maximum
  loading dose of 5 mg/day.
• The atypical antipsychotics
• risperidone, olanzapine, quetiapine,and
  aripiprazole.

• Other medications, such as valproate,
  donepezil, or ondansetron,may be
  effective and safe in selected cases.
THANK YOU……

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Delirium

  • 1. DELIRIUM ETIOLOGY & PREDISPOSING FACTORS INVESTIGATION & TREATMENT
  • 2. ETIOLOGY • A) Metabolic disorders -  Hypoglycemia,  Hypoxia,  Fluid & electrolyte disturbances,  Dehydration  Disturbances of Ca, Mg.
  • 3.  Hyponatremia.  Liver & kidney failure.  Endocrinopathies (thyroid, parathyroid, pituitary),  Porphyria  Thiamine def.
  • 4. B) Drug related • Sedative-hypnotics. • Anticholinergics • Antihistaminic drugs. • Psychotropics. • Anticonvulsants. • Narcotic analgesics. • Withdrawal syndromes. • Delirium tremens.
  • 5. • c) Infections  Meningitis.  Encephalitis,  Brain abscess,  Pneumonia  Lyme disease.  AIDS  Septicemia
  • 6. • D) Neurological  Strokes,  Epilepsy,-postictal  Head injury,  Hypertensive encephalopathy,  Brain tumors,
  • 7. • E) Postoperative Specific surgeries. anesthetic and other drug effects, Electrolyte imbalances. hypoxia and anemia, fragmented sleep, pain
  • 8. • F) Miscellaneous  Anemia  Cerebral vasculitides.  Paraneoplastic and limbic encephalitis.  Trauma.  Dehydration.  Electrocution.  attempted hanging
  • 9. Predisposing factors Advanced age. Dementia. Fluid and electrolyte disturbances dehydration Other metabolic disturbance.  hepatic insufficiency.
  • 11. contd… Polypharmacy and use of analgesics, psychoactive drugs, or anticholinergics. Drug abuse, alcohol or sedative dependency. Sleep disturbance.
  • 12.  Fever, hypothermia Physical trauma or severe burns Fractures Male gender Depression
  • 13. Investigations • Blood cell count • Blood glucose • Blood-urea, nitrogen, creatinine, transaminase,ammonia levels. • Thyroid fn tests. • Chest x-rays • EEG changes
  • 14.
  • 15. contd… • Arterial blood gas studies • ECG • Urine analysis. • Lumbar puncture • Neuroimaging
  • 16. MANAGEMENT I. finding the cause and eliminating it • with symptomatic measures involving attention to fluid and electrolyte balance, nutritional status, and early treatment of infections.
  • 17. II. environmental interventions • . Reduce unfamiliarity by providing a calendar, a clock, family pictures, and personal objects. • Maintain a moderate sensory balance in the patient by avoiding sensory overstimulation or deprivation.
  • 18. • Other environmental measures :- include providing soft music and warm baths, and allowing the patient to take walks when possible. • Proper communication and support.
  • 19. • It is best to avoid the use of drugs in confused patients because their effects further cloud the clinical picture and may worsen the delirium.
  • 20. • MEDICATION is necessary if the patient’s behavior is potentially dangerous, interferes with medical care. • Haloperidol (starting at 0.25 mg daily) repeated every 30 minutes, given (PO) or (IM), up to maximum loading dose of 5 mg/day.
  • 21. • The atypical antipsychotics • risperidone, olanzapine, quetiapine,and aripiprazole. • Other medications, such as valproate, donepezil, or ondansetron,may be effective and safe in selected cases.