Aquifer Internal Medicine Case 25
pt with AMS 3 D's correct answersDementia: chronic confusional state that develops slowly, over months to years
Delirium: acute disturbance in consciousness and perception with an underlying medical
etiology
Depression: primarily a mood disorder but can present as confusion in older adults
risk factors delirium correct answersadvanced age >85
diminished ADLs
immobility
pain
sensory impairment dementia
psychiatric disorder
sleep deprivation
malnutrition
dehydration
substance use disorders
co-morbid illness (CKD, ESRD)
"high risk" medication use admission to ICU
A-I-D-A correct answersAcute onset/fluctuating
Inattention
Disorganized thinking
Altered level of consciousness (vigilant = hyper alert, lethargic = drowsy, easily aroused,
stupor = difficult to arouse, coma = unarousable
medications associated with delirium correct answersbenzodiazepines
zolpidem
opioids
anticholinergics (promethazine, diphenhydramine aka Benadryl)
corticosteroids alpha-2-agonist fluoroquinolone (ciprofloxacin)
etiology delirium correct answersurinary catheters, sensory deficits, loss sleep-wake cycle, sleep deprivation, malnutrition, constipation and urinary retention
cause of hypotonic hyponatremia: impaired renal water excretion correct answershypovolemic: diuresis, adrenal insufficiency, salt-wasting nephropathy, bicarbonaturia, ketonuria, diarrhea, vomiting, blood loss, excessive sweating, fluid sequestration (third spacing)
pt with AMS 3 D's correct answersDementia: chronic confusional state that develops slowly, over months to years
Delirium: acute disturbance in consciousness and perception with an underlying medical
etiology
Depression: primarily a mood disorder but can present as confusion in older adults
risk factors delirium correct answersadvanced age >85
diminished ADLs
immobility
pain
sensory impairment dementia
psychiatric disorder
sleep deprivation
malnutrition
dehydration
substance use disorders
co-morbid illness (CKD, ESRD)
"high risk" medication use admission to ICU
A-I-D-A correct answersAcute onset/fluctuating
Inattention
Disorganized thinking
Altered level of consciousness (vigilant = hyper alert, lethargic = drowsy, easily aroused,
stupor = difficult to arouse, coma = unarousable
medications associated with delirium correct answersbenzodiazepines
zolpidem
opioids
anticholinergics (promethazine, diphenhydramine aka Benadryl)
corticosteroids alpha-2-agonist fluoroquinolone (ciprofloxacin)
etiology delirium correct answersurinary catheters, sensory deficits, loss sleep-wake cycle, sleep deprivation, malnutrition, constipation and urinary retention
cause of hypotonic hyponatremia: impaired renal water excretion correct answershypovolemic: diuresis, adrenal insufficiency, salt-wasting nephropathy, bicarbonaturia, ketonuria, diarrhea, vomiting, blood loss, excessive sweating, fluid sequestration (third spacing)
