Delirium Care Pathways

Identify and address the causes of Delirium

Page last updated: 07 November 2011

In order to identify and address the causes of delirium, a comprehensive initial evaluation should be performed that includes the following components:

(i) Obtain history

  • Medication
    • recent changes
    • include prescription and over-the-counter medications
  • Dehydration – diuretics use, hot weather
  • Falls
  • Infection
  • Bladder and bowel function
  • Premorbid cognitive and functional status
  • Alcohol history
  • Past medical history and comorbidities
  • Social history
  • History of dietary and fluid intake
  • Sensory impairments

This information can be obtained from a number of sources such as documented in medical record from previous admissions and consultation with the person with delirium, their general practitioner and/or carer/family members. People with delirium may provide unreliable histories and information should be sought from family members, GP, residential care staff, etc.

(ii) Examination

  • Obtain vital signs – temperature, pulse, respirations, blood pressure (lying and standing), and oxygen saturation
  • Mental state examination
    • Decreased arousal
    • Decreased attention
    • Disorientation
  • Neurological examination
    • New signs
  • Chest
    • Auscultation
    • Cough
  • Abdomen
    • Palpable faeces/faecal impaction
    • Palpable bladder/urinary retention
  • Skin
    • Lesions
    • Signs of dehydration

(iii) Investigations

The following investigations are used to screen for common causes of delirium:
  • Urinalysis and MSU (if urinalysis abnormal)
  • Full blood examination
  • Urea and electrolytes
  • Glucose
  • Calcium
  • Liver function tests
  • Chest x-ray
  • Cardiac enzymes
  • ECG
Further investigations will be dependant upon clinical features and expert consultant advice, and may include:
  • Specific cultures eg blood and sputum (if fever present, cough and/or abnormal chest radiograph)
  • Arterial blood gases (if short of breath, cough and/or abnormal chest radiograph)
  • CT brain (if history of falls, patient/client on anticoagulant therapy or focal neurological signs present)
  • Lumbar puncture (if headache and fever and meningism present)
  • EEG (may assist in determining aetiology eg non-convulsive status epilepticus)
  • Thyroid function tests
  • B12 and folate

Adapted from: Clinical Epidemiology and Health Services Evaluation Unit 2006, Clinical Practice Guidelines for the Management of Delirium in Older People, Victorian Government Department of Human Services, Melbourne, Victoria