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17 Cards in this Set
- Front
- Back
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What is delirium?
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Disturbance of mental function that usually involves diffuse impairment of cortical function with impaired speed, clarity, and coherence of thinking.
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What is the main risk for delirium? Other vulnerabilities?
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Advanced age
Other vulnerabilities: Underlying cognitive impairment/brain dz Sleep and sensory deprivation/unfamiliar env meds |
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What are the clinical features of delirium? What features sometimes appear?
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Fluctuating levels of alertness and attn
Decreased [ ], coherent thought and skilled mvmts Disorientation, memory and language deficits Nocturnal exacerbations (May also include: Autonomic instability--wide swings in BP, HR, temp; Tremor, myoclonus, hyperreflexia, dysarthria--slurred speech, seizures) |
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Why is dementia a risk factor for delirium?
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Pts with dementia are sensitive to the effects of psychotropic drugs
(DEMENTIA AND DELIRIUM ARE NOT MUTUALLY EXCLUSIVE) |
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What are possible causes of encephalopathy?
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Toxins (EtOH, street drugs, Rx meds, heavy metals)
Withdrawal states Electrolite disturbance Hypoxia, HTN Dz (herpes, lupus) Stroke, head trauma, seizures, dementia |
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How does alcohol abuse result in dementia?
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Frontal lobe and cerebellar atrophy
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What electrolyte imbalances occur as a result of alcoholism?
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Hyponatremia
Hypomagnesemia Hypocalcemia |
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How does Wernicke's encephalopathy arise?
Symptoms? Treatment? |
Alcoholism-->thiamine deficiency-->lesion in thal and hthal
Syx: Ophthalmoparesis (nystagmus), gait ataxia, confusion Tx: Thiamine replacement |
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Hyponatremia:
Cause Symptoms Treatment |
Overhydration, may be med-induced (diuretics)
Syx: confusion, seizures Tx: MUST BE corrected slowly to avoid central pontine myelinolysis |
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Hyperglycemia:
Cause Symptoms |
Cause: tx of DM
Syx: Sluggishness, stupor and coma at higher levels, along with focal or generalized SEIZURES (generalized seizures in hypoglycemia) |
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Hypocalcemia & Hypercalcemia:
Causes Symptoms |
Hypocalcemia:
Hypo-parathyroidism Malnutrition Syx: Tetany Hypercalcemia: Hyper-parathyroidism, mets, sarcoid Syx: Sluggishness, confusion, psychosis |
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Hyperammonemia:
Causes Effects Treatment |
Hyperammonemia:
Hepatic failure, exacerbated by high protein load in GI tract (GI bleeding) Depletion of brain ATP (glutamine regulates NH3; glutamine synthesis dependent on ATP) Tx: Protein-restriction, elimination of protein from GI tract |
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Elevated BUN:
Symptoms |
Apathy, fatigue first, then confusion, disorientation
Can also lead to acude rendal failure, confusion, twitching, jerking (Patients on dialysis may tolerate high BUN levels with minimal syx) |
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What are the dangers of valproate?
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Can cause encephalopathy even in therapeutic range
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How does a normal EEG differ from an encephalopathic EEG?
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Encephalopathic EEG will be more syncronous with peaks of greater amplitude
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If a patient presents with Parkinsonism and demented episodes, what kind of dementia does he/she have?
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Dementia with Lewey Bodies
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Why would Sinemet (an anti-Parkinson's drug) cause dementia?
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DA replacement
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