1st order laboratory parameters – obligatory laboratory tests. Small blood count [MCV ↑ in alcohol abuse and myxedema] Differential blood count Inflammatory parameter – CRP (C-reactive protein) Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, urobilinogen, bilirubin, blood), sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing suitable antibiotics … Delirium: Test and Diagnosis
Therapy goals Relief of symptoms As far as available: Balancing the electrolyte and water balance. Correction of a metabolic disorder Treatment of an infection Prevention of social restrictions Therapy recommendations Inpatient monitoring (a potentially life-threatening condition is present). Symptom-oriented and prompt therapy Analgesics (painkillers) and sedatives (tranquilizers) should not be abruptly discontinued, but phased out. … Delirium: Drug Therapy
Obligatory medical device diagnostics. Electrocardiogram (ECG; recording of the electrical activity of the heart muscle). Abdominal sonography (ultrasound examination of the abdominal organs) – for basic diagnostics. X-ray of the thorax (X-ray thorax/chest), in two planes [may indicate hypoxia: e.g., evidence of heart failure/heart failure, pneumonia/pneumonia]. Optional medical device diagnostics – depending on the results … Delirium: Diagnostic Tests
To prevent delirium, attention must be paid to reducing individual risk factors. Reinforce delirium risk: Behavioral risk factors Diet Malnutrition Consumption of stimulants Alcohol (here: alcohol abuse) Drug use Amphetamines and metamphetamines (“crystal meth”). Ecstasy (also XTC and others) – collective name for a variety of phenylethylamines. GHB (4-hydroxybutanoic acid, obsolete also gamma-hydroxybutanoic acid or … Delirium: Prevention
The following symptoms and complaints may indicate delirium: Leading symptoms Cognitive disturbance (memory impairment) with impaired perception (disorientation), fluctuating over hours/days Attention deficit Restriction of perception, speech, etc. to varying degrees. Altered sleep-wake rhythm, ie reversal of the day-night rhythm. (Optical) hallucinations, delusions. Affective disorders Signs of hypoactive delirium Withdrawn into himself Apathy (apathy) Psychomotor … Delirium: Symptoms, Complaints, Signs
Medical history (history of illness) represents an important component in the diagnosis of delirium. Family history What is the general health of your family members? Are there any diseases in your family that are common? Isolation, change of location, losses or grief? Social history What is your profession? Current medical history/systemic history (somatic and psychological … Delirium: Medical History
Respiratory System (J00-J99) Pulmonary insufficiency with hypoxemia (decreased blood oxygen content) and hypercapnia (increased blood carbon dioxide content). Pneumonia (inflammation of the lungs) Blood, blood-forming organs – immune system (D50-D90). Anemia (anemia) Autoimmune diseases such as vasculitis (inflammation of blood vessels) of the central nervous system (CNS) and cerebral lupus. Endocrine, nutritional and metabolic diseases … Delirium: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by delirium: Psyche – Nervous System (F00-F99; G00-G99). Recurrent delirium (recurrent delirium). Cognitive deficits Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99). Propensity to fall Further Social restrictions Nursing home admission (seniors; because of postoperative cognitive deficit (POCD) … Delirium: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes, and sclerae (white part of the eye) [symptoms of delirium tremens (alcohol withdrawal delirium): sweating, tremor (shaking; assessing fluid balance (e.g., signs of desiccosis (dehydration)) Auscultation … Delirium: Examination
Pathogenesis (development of disease) Delirium may be due to many different causes. The deficit in attention is thought to be localized in the brainstem, medial dorsal thalamus (forms most of the diencephalon), prefrontal cortex (part of the frontal lobe of the cerebral cortex, located at the front of the brain), and right temporal lobe. Delirium … Delirium: Causes
General measures Create a quiet and safe environment Bringing relatives and patient together Touch by familiar people Use of visual and hearing aids Adherence to a day-night rhythm Reorientation with time and calendar Promotion of mobilization Ensure adequate hydration Review of permanent medication due topossible effect on the existing disease; if possible, discontinue high-risk medications, … Delirium: Therapy