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

Diagnostic procedures

• electroencephalography if suspected non-convulsive status epilepticus*

* after other etiologies ruled out

Radiology

• CT of head of low yield (13%)

Differential diagnosis

• depression vs hypoactive delirium
  • 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

More general terms

• delirium (acute confusional state)