What is the diagnostic workup and treatment for delirium (Delerium)

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Last updated: May 26, 2025 • View editorial policy

From the Guidelines

Delirium diagnosis and treatment should prioritize a systematic approach, starting with identification of the condition through clinical assessment using validated tools like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or Intensive Care Delirium Screening Checklist (ICDSC), as recommended by the most recent guidelines 1. To diagnose delirium, the following steps should be taken:

  • Evaluate for acute onset of fluctuating attention, disorganized thinking, and altered level of consciousness
  • Obtain a thorough history, focusing on medication changes, recent illnesses, and baseline cognitive function
  • Conduct a comprehensive physical examination and order appropriate laboratory tests, including complete blood count, comprehensive metabolic panel, urinalysis, blood cultures, and toxicology screening
  • Brain imaging (CT or MRI) may be necessary if neurological causes are suspected Treatment involves addressing the underlying cause while implementing non-pharmacological interventions, such as:
  • Maintaining a normal sleep-wake cycle
  • Providing orientation cues
  • Ensuring adequate hydration
  • Involving family members For severe agitation that poses safety risks, low-dose antipsychotics may be used cautiously, with haloperidol 0.5-1mg orally or intramuscularly being a recommended option, as stated in the guidelines 1. Benzodiazepines should generally be avoided except in alcohol withdrawal delirium, where lorazepam 0.5-1mg every 4-6 hours may be appropriate. It is essential to note that delirium management is urgent, as the condition increases mortality risk, prolongs hospitalization, and may lead to long-term cognitive impairment, with prevention being equally important through regular orientation, early mobilization, and minimizing unnecessary medications 1.

From the Research

Diagnosis of Delirium

  • Delirium is characterized by acute, fluctuating altered levels of consciousness, inattention, and cognitive function disorders 2
  • The diagnosis is clinical but can be challenging due to overlapping symptoms with dementia and depression 3
  • The Confusion Assessment Method (CAM) is a screening tool that is 94% to 100% sensitive for detecting delirium 3

Assessment Scales for Delirium

  • The Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) are validated instruments for the diagnosis of delirium 4, 5
  • The Delirium Rating Scale-Revised-98 (DRS-R-98) and the Delirium-O-Meter (DOM) are also used for monitoring the course of delirium 2
  • The Intensive Care Delirium Screening Checklist (ICDSC) has moderate sensitivity and good specificity for diagnosing delirium in critically ill patients 5

Risk Factors for Delirium

  • Older age, multiple comorbidities, recent surgery, and polypharmacy are independent risk factors for delirium 3
  • Metabolic and electrolyte disturbances are also predisposing and precipitating factors for delirium 2

Treatment and Management of Delirium

  • Haloperidol and new antipsychotic drugs are recommended pharmacological treatment methods for delirium 2, 3
  • Non-pharmacological interventions, such as routine screening of cognitive functions and comprehensive medical and nursing care, are also recommended 2
  • Prevention and early detection of delirium are crucial, as patients hospitalized with prolonged delirium have a higher risk of mortality 3

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.