28 PCN Delerium Definition and Causes
Delerium Criteria: corresponds with ICU/CAM
- Feature 1 = acute change or fluctuating course of mental status AND
- Feature 2 = inattention
- Instruct to squeeze hand with letter “A”
- SAVEAHAART
AND - Either Feature 3 or Feature 4
- Feature 3 = Disorganized Thinking
- Use either a or b:
- will a stone (leaf) float on water
are there fish (elephants) in the sea
does 11/21 pounds weigh more than 21/11 pounds
can you use a hammer to pound a nail (cut wood) - hold up this many (2) fingers, now with the other hand
- will a stone (leaf) float on water
- Use either a or b:
- Feature 4 = altered Level of Consciousness (RASS other than 0)
Delerium Differential Diagnosis:
| Type | Description |
| Metabolic | (Ca++, Na+, renal, hepatic, thyroid, O2, glucose) |
| Infectious | (UTI, Pneum, cellulitis, wound, IVC, CNS) |
| Comorbidity | (constipation, urine retention, PE, MI, stroke) |
| Cancer-related | (leptomeningeal, mets, RT, paraneoplastic) |
| Seizure | (complex, partial, postictal) |
| Deficiency | (B12, thiamine, HgB) |
| Recent surgery | (anesthesia, sedation) |
| Substance | (opioid, benzo, anti-Ach, anti-histamine, NSAID, steroid) |
| Multi-factorial | |
| Terminal | (restlessness often combination of progressive disease, dehydration, accumulation of metabolites from organ failure) |
