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:
      1. 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)
      2. hold up this many (2) fingers, now with the other hand
  • 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)

License

Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Reference Notes for Palliative Care Consultation Copyright © 2018 by Robert F. Johnson MD, MEd is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

Share This Book