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hypoactive delirium
Etiology:
- uncontrolled pain
- pharmaceuticals
- parasympatholytics
Epidemiology:
- postoperative common, especially after nerve block wears off
- accounts for ~50% of delirium cases
Clinical manifestations:
- features of delirium & depression
- hypersomnia & inattention
Laboratory:
- plasma ammonia if cirrhosis & suspected hepatic encephalopathy
- sensitivity 47%, specificity 78%
- of secondary importance in patients with cirrhosis to medication review
Special laboratory:
- electroencephalography if suspected non-convulsive status epilepticus*
* after other etiologies ruled out
Radiology:
- CT of head of low yield (13%) [2]
Differential diagnosis:
- depression vs hypoactive delirium [1]
- depression must be present for at least 2 weeks
- non-convulsive status epilepticus
Management:
- treatment pain
- non-pharmacologic manamgement of delirium
- antipsychotics not indicated in the absence of agitated delirium with patient presenting risk to themselves or others
General
delirium (acute confusional state)
References
- Geriatric Review Syllabus, 10th edition (GRS10)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2019
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- Akhtar H et al.
Diagnostic yield of CT head in delirium and altered mental status-
A systematic review and meta-analysis.
J Am Geriatr Soc 2023 Mar; 71:946.
PMID: 36434820
https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18134