Delirium physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]; Vishal Khurana, M.B.B.S., M.D. [3]

Overview

It is important to do a thorough physical examination to find out the underlying etiology of delirium.

Physical Examination

  • Delirium symptom changes in severity during its course.
  • It is essential to assess the patient multiple times, as it is easy to miss a diagnosis, also features like sundowning can be overlooked if the assessment is not done towards the end of the day.

General Examination

  • Temperature:

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  • Nutritional status: B12 and folate deficiencies can be assessed on physical examination.
  • Hydration state: Dehydration as well as an overload of fluids, resulting in hypoxia can cause delirium.
  • Infectious foci: Careful examination to rule out conditions such as meningitis, encephalitis, pulmonary consolidation etc.
  • Evidence of intoxication or withdrawal for alcohol, and recreational drugs are an important part of delirium work up. Look for tremors, pupil size, needle tracks etc.

Systemic Examination

References

  1. Lees, Rosalind; Corbet, Sinead; Johnston, Christina; Moffitt, Emma; Shaw, Grahame; Quinn, Terence J. (2013). "Test Accuracy of Short Screening Tests for Diagnosis of Delirium or Cognitive Impairment in an Acute Stroke Unit Setting". Stroke. 44 (11): 3078–3083. doi:10.1161/STROKEAHA.113.001724. ISSN 0039-2499.

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