Delirium Mnemonics
DELIRIUM (S)
Differential diagnosis for patients with Delirium
(remember: delirium usually has more than one cause)
| D | Drugs, Drugs, Drugs |
| E | Eyes, ears 1 |
| L | Low 02 states (MI, ARDS, PE, CHF, COPD) 2 |
| I | Infection |
| R | Retention (of urine or stool), Restraints |
| I | Ictal |
| U | Underhydration/Undernutrition |
| M | Metabolic |
| (S) | Subdural, Sleep deprivation |
causes, but should be "fixed" or improved if possible. Cerumen is
common cause of hearing impairment.
2 "Low 02 states" does NOT necessarily mean hypoxia, rather it is a
reminder that patients with a hypoxic insult (e.g. Ml, stroke, PE) may
present with mental status changes with or without other typical
symptoms/signs of these diagnoses.
'I WATCH DEATH'
Differential Diagnosis of Delirium
Infection HIV, sepsis, Pneumonia Withdrawal Alcohol, barbiturate, sedative-hypnotic Acute metabolic Acidosis, alkalosis, electrolyte disturbance, hepatic failure, renal failure Trauma Closed-head injury, heat stroke, postoperative, severe burns CNS pathology Abscess, hemorrhage, hydrocephalus, subdural hematoma, Infection, seizures, stroke, tumors, metastases, vasculitis, Encephalitis, meningitis, syphilis Hypoxia Anemia, carbon monoxide poisoning, hypotension, Pulmonary or cardiac failure Deficiencies Vitamin B12, folate, niacin, thiamine Endocrinopathies Hyper/hypoadrenocorticism, hyper/hypoglycemia, Myxedema, hyperparathyroidism Acute vascular Hypertensive encephalopathy, stroke, arrhythmia, shock Toxins or drugs Prescription drugs, illicit drugs, pesticides, solvents Heavy Metals Lead, manganese, mercury COCOA PHSS
Differentiating Delirium from Dementia
Delirium Dementia Consciousness Decreased or hyper alert Alert "Clouded" Orientation Disorganized Disoriented Course Fluctuating Steady slow decline Onset Acute or sub acute Chronic Attention Impaired Usually normal Psychomotor Agitated or lethargic Usually normal Hallucinations Perceptual disturbances Usually not present May have hallucinations Sleep-wake-cycle Abnormal Usually normal Speech Slow, incoherent Aphasic, anomic difficulty finding words *Adapted from: Saint Louis University Geriatrics Evaluation Mnemonics Screening Tools (SLU GEMS). Developed or compiled by: Faculty from Saint Louis University Geriatrics Division and St. Louis Veterans Affairs GRECC.
Vanderbilt University Medical Center
Veterans Affairs TN Valley Geriatric Research Education and Clinical Center (GRECC)