Delirium – Potentially deliriogenic medications
Analgesics NSAIDs, opioids (especially meperidine) Antibiotics Aminoglycosides, amphotericin B, antimalarials, cephalosporins, cycloserine, fluoroquinolones, isoniazid, interferon, linezolid Antibiotics (cont) Macrolides, metronidazole, nalidixic acid, penicillins, rifampin, sulfonamides Antivirals Acyclovir Anticholinergics Atropine, benztropine, diphenhydramine, scopolamine, trihexyphenidyl Anticonvulsants Carbamazepine, …
Delirium – Work up for unclear etiology
Pearls: In the absence of fever/leukocytosis, hemodynamic, and localizing urinary symptoms, delirium is not a sign of UTI and other etiologies should be evaluated. Any bacteriuria should be viewed as asymptomatic and not subject to …
Delirium – Difficulty identifying predisposing and precipitating factors
If you have not been able to identify precipitating delirium factors on the initial evaluation, an additional search is needed. Below are further considerations A comprehensive evaluation is outlined here Predisposing factors Consider reevaluating premorbid …
Delirium – Predisposing and Precipitating factors
Predisposing Predisposing factor Relative Risk Cognitive impairment 2.1-4.2 Dementia 2.3-4.7 Sensory impairment (vision or hearing) 1.1-3.5 Depression 1.2-3.2 Alcohol misuse 1.4-5.7 Age 75+ 1.1-6.6 Table adapted from: Inouye SK, Westendorp RG, Saczynski JS. Delirium in …
Delirium – History and Physical
History: Physical: Vital signs (+/- orthostatic vitals) and fingerstick/serum glucose Physical Exam: Laboratory/Imaging The laboratory and imaging work up should be guided suspicion based on history and physical. At a minimum, obtain CBC, CMP (basic …
Delirium – Avoid using antipsychotics if QTc is prolonged
If the patient has an indication for antipsychotics (due to behavior that is a danger to self or others or distressing psychosis) but the use in contraindicated due to a prolonged QTc, there are limited …
Delirium – The basic benefits and risk of antipsychotics
Antipsychotic use should be reserved only for severe agitation who: Risk interruption of essential medical treatment (self extubating, etc.) Self injury or injury to others Experience severe, distressing psychotic symptoms (hallucinations, delusions, etc.) PEARL: Antipsychotics …
Delirium – Gold Standard Nonpharmacologic Treatment Checklist
Pearl: These nonpharmacologic interventions are the gold standard to delirium care in the hospital and have been found to prevent delirium by 30-40%! (Postoperative delirium in older adults: best practice statement from the American Geriatrics …
Delirium – Delirium Diagnosed
Classification of delirium: After delirium is diagnosed, consider a geriatrics consultation*. *Geriatric consults have been found to prevent the rates of delirium by around 30%. However, data on reduction of delirium severity and length of …