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Delirium

Whitney A. Gray, CRNP, MSN and Katrina A. Booth, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A temporary neurologic complication of illness and/or medication(s), especially common in older patients, manifested by new confusion and impaired attention

  • A medical emergency requir...

DIAGNOSIS

Diagnosis is made using a careful history, behavioral observation, and cognitive assessment. 
  • DSM-5 diagnostic criteria include (1):

    • Disturbance in attention and awareness

    • Change in cognition...

TREATMENT

  • The best treatment is prevention (3)[A].

  • Addressing six risk factors (i.e., cognitive impairment, sleep deprivation, dehydration, immobility, vision impairment, and hearing impairment) in at-...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

  • If delirium at discharge, often needs postacute facility and ongoing assessment for resolution

  • If no delirium at discharge, follow up with primary care physician i...

REFERENCES

1
1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
2
2 Van Eijk MM, van Marum RJ, Klijn...

ADDITIONAL READING

  • Inouye SK, Robinson T, Blaum C, et al. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc.  2015;63...

SEE ALSO

  • Dementia; Depression; Substance Use Disorders

  • Algorithm: Delirium

CODES

ICD10

  • R41.0 Disorientation, unspecified

  • F19.931 Oth psychoactive substance use, unsp w withdrawal delirium

  • F10.231 Alcohol dependence with withdrawal delirium

  • F05 Delirium due to known physiological...

CLINICAL PEARLS

  • The CAM criteria for delirium are acute onset of fluctuating mental status, inattention, and either disorganized thinking or altered level of consciousness.

  • Hypoactive subtype of deliri...

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