Delirium

Delirium means an impaired quality of consciousness accompanied with confusion. It is unfortunately a quite common condition, especially in the inpatient wards.

Causes

There are more factors contributing to delirium occurrence. Older age is an important risk factor as the brain functions deteriorate with age and there is often dementia present. This makes the elderly in general more susceptible to a delirium bout. Another risk factor is a sudden change of the patient’s surroundings. A person who is put into unknown surroundings has a higher risk of delirium occurrence, especially at night. When a senior is hospitalized in an inpatient ward, these three factors usually combine.

Delirium usually occurs in chronic alcoholics who suddenly withdraw the alcohol consumption. This is for example the case of alcoholics admitted to the inpatient ward who have very high chance of a delirium development. This delirium is accompanied by hand tremor and hallucinations and we name it as the so-called delirium tremens.

Other factors contributing to the patient’s confusion may be conditions disrupting brain functions and the internal environment, for example stroke, acute kidney failure, liver failure, sepsis, meningitis, epilepsy and dehydration.

Symptoms

Delirium manifests with impaired orientation in time, place and person. The affected person does not know the time, do not recognize his or her surroundings and previously known persons. The confusion is accompanied by change of emotions (joy, anger, and anxiety), increased activity (shouting, attacking other people and hospital staff, meaningless actions and attempts to escape) and hallucinations. After decline of the delirium bout, the patient usually does not remember it.

Prevention

Absolute prevention is usually not possible in old hospitalized patients as the main risk factors can not be removed. It is important to keep the patients fully hydrated and preventively administer some antipsychotic drugs.

Treatment

Proper treatment of delirium is of a great importance because it lowers the risk that the patient hurts himself or other people. Sedative drugs are used usually from groups of benzodiazepines and antipsychotics. In acute phase of delirium they are administered intravenously on intramuscularly. The effect of the drugs is unfortunately individual.

In case of necessity it is sometimes needed to temporarily use physical limiting means, i.e. to strap the patient to the bed. Delirium tremens is treated similarly; we should use large doses of benzodiazepines as the hand tremor occurs.