inpatient / neurology

Delirium and Agitation

Last Updated: 1/6/2023

# Delirium
# Agitation

-- History: *** age >65, h/o CVA/TIA or dementia, prolonged hospitalization, infection, visual/hearing impairment, depression
-- Clinical: *** Acute and fluctuating course + inattention along with either disorganized thinking or AMS
-- Exam: *** focal neuro deficits, evidence of infection
-- Data: *** infectious w/u, CBC, BMP, coags, VBG, lactate, TSH, UDS, thiamine/B12; CT Head
-- Etiology/DDx: *** metabolic (glucose, lyte, hypercarbia, thyroid, hepatic), infection (UTI, PNA, bacteremia meningitis/encephalitis), Structural (stroke, seizure/post-ictal, tumor), Toxin (opioids, EtOH/benzo, iatrogenic), Delirium/Dementia/Depression; Rarer (HIV, lyme, nutritional, HTN, PRES

-- Minimize deliriogenic meds (anticholinergics, antihistamines, benzos, opioids)
-- Frequent re-orientation, lights on during day/off at night, avoid late night draws or meds, reduce noise, out of bed with nursing and PT/OT, glasses or hearing aid in, minimize lines/telemetry/catheters
-- Standing melatonin 3mg
-- Agitation plan: *** re-orient --> 1:1 --> PO meds (haldol, quetiapine) --> IV meds (haldol 2-5mg IV q3 PRN) --> restraints
-- Consider standing qhs medications - haldol, quetiapine, olanzapine
-- Consult psych or geriatrics if continued severe agitation
-- Monitor QTc q3 days or with medication changes and replete K >4 and Mg >2

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