Would You Recognize Acute Delirium?

Kevin Biese, MD; Adam Perry, MD


March 28, 2018

This case was developed in cooperation with West Health Institute, a nonprofit organization that conducts applied medical research spanning healthcare in the home, hospital, and community-based organizations. West Health Institute is studying how senior-specific healthcare delivery can be improved to enable successful aging in place and improve care for seniors and their families.

An Older Woman With Decreased Mental Status

Mrs Smith, an 87-year-old resident at a nearby nursing home, is brought to the emergency department (ED) by ambulance for evaluation of a 2-day history of "decreased mental status" and "failure to thrive." The transfer form records that she has been "sleeping all day" and "not taking PO."

Source: Alamy

Medical history is listed as: hypertension, congestive heart failure, and dementia. Medications include: lisinopril 10 mg daily, furosemide 40 mg twice per day, and donepezil 10 mg daily.

She appears drowsy, opening her eyes to voice and falling asleep during conversation. She offers no complaints. She is oriented to person, place, and year; not day or date. She is unable to recite months of the year backwards. Oral mucosa appears dry. Vital signs and the remainder of the exam are noncontributory. She is 5'2" and 108 pounds. Laboratory values are remarkable for sodium 148 mmol/L, blood urea nitrogen 24 mg/dL, and creatinine 1.6 mg/dL.

Your colleague explains that she had ordered a basic metabolic panel, complete blood count, chest x-ray, and noncontrast brain CT. Disposition is pending CT read, which is returned 1 hour later with findings of, "no acute disease; age-related changes."


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