title: "Delirium"
Delirium
Key Facts
Delirium is an acute, fluctuating disturbance of attention and awareness with additional cognitive change due to an underlying medical cause.
Hypoactive delirium is common and easily missed; the key bedside feature is inattention.
Overview
This article covers recognition, assessment, and first-line management principles.
Recognition
- Acute onset (hours–days) and fluctuating course
- Inattention (difficulty sustaining focus)
- Altered level of consciousness and disorganised thinking
Initial assessment (high level)
- ABCs and time-critical causes (hypoxia, hypoglycaemia, sepsis, intracranial event)
- Review medications (sedatives, anticholinergics, opioids) and consider withdrawal
- Look for common precipitants: pain, urinary retention, constipation, dehydration
Management principles (high level)
- Treat underlying cause(s) and optimise physiology
- Non-pharmacological measures: reorientation, sleep-wake cycle, mobilise, hydration/nutrition, glasses/hearing aids, family support where possible
- Avoid benzodiazepines unless treating alcohol/benzodiazepine withdrawal; if medication is required for severe agitation, follow local policy and use the lowest effective dose
Sources
- Australian Delirium Clinical Care Standard (ACSQHC)
- CC Bible
- DSM-5
Test Your Knowledge
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Related Topics
See also: The Deteriorating Patient & ABCDE Approach, Sepsis & Septic Shock, Approach to the Poisoned Patient