What are the most common precipitants of delirium in children?
Febrile illnesses and medications
How does delirium generally manifest on electroencephalography (EEG)?
Diffuse background slowing
What is the exception to the EEG findings in delirium?
Delirium tremens, which is associated with fast activity
What is the utility of EEG in diagnosing delirium?
It lacks sensitivity and specificity but is useful for ruling out non-convulsive seizures
What are key indicators to assess in a bedside exam for delirium?
- Alertness level
- Eyes (pupil size and position)
- Urine (bladder distension or incontinence)
- Mucous membranes (moisture)
- Skin (temperature and moisture)
What symptoms should raise suspicion for delirium?
Altered mental status, disorientation, confusion, agitation, or new-onset psychotic symptoms
List typical symptoms of delirium.
- Short attention span
- Disorientation
- Fluctuations in level of consciousness
- Visual hallucinations
- Impairment in recent memory
What is the likely diagnosis for delirium with hemiparesis or other focal neurological signs?
CVA or mass lesion
What condition is associated with delirium, elevated blood pressure, and papilledema?
Hypertensive encephalopathy
What is the likely diagnosis for delirium with dilated pupils and tachycardia?
Drug intoxication
What diagnosis is associated with delirium, fever, nuchal rigidity, and photophobia?
Meningitis
What is the likely diagnosis for delirium with tachycardia and tremor?
Thyrotoxicosis
What features may accompany delirium aside from cognitive symptoms?
Deficits in recent memory, language abnormalities, or perceptual disturbances
What are the three types of delirium based on psychomotor activity?
- Hypoactive
- Hyperactive
- Mixed
What diagnostic tests are useful in evaluating delirium?
- Head CT/Brain MRI
- Urine toxicology screen
- Lumbar puncture
- Free T, T4, TSH
What is the expected recovery time for most hospitalized patients with delirium?
About 1 week, although some cognitive deficits can persist
What is the Confusion Assessment Method (CAM)?
A clinical tool for evaluating a patient with suspected delirium, taking only 5 minutes to perform
What are the DSM-5 diagnostic criteria for delirium?
Inattention of acute onset and/or fluctuating course along with either disorganized thinking or altered consciousness
How does inattention manifest in patients with delirium?
Distractibility or difficulty maintaining focus during the evaluation
