A 78-year-old woman with a CFS of 5 is admitted to the acute medical unit with acute confusion. Her son reports she has been increasingly muddled over...

Question

A 78-year-old woman with a CFS of 5 is admitted to the acute medical unit with acute confusion. Her son reports she has been increasingly muddled over 48 hours. She has a background of type 2 diabetes, hypertension, and mild cognitive impairment (MoCA 24/30 three months ago). On examination she is drowsy, picking at the bedsheets, and unable to state the month or year. Her 4AT score is 11. Temperature 36.8C, HR 88, BP 140/78, SpO2 96%. Urinalysis is negative. CRP 8. What is the MOST important next step?

Accepted Answer

Perform a comprehensive assessment for the cause of delirium including medication review, bladder scan, rectal examination for constipation or faecal loading, blood glucose, electrolytes, calcium, thyroid function, and chest X-ray

Answer

Start Haloperidol for her agitation

Answer

Diagnose her with rapid-onset dementia and refer to the memory clinic

Answer

Discharge home as her observations are normal

Answer

Arrange an urgent lumbar puncture

uk-dgm MCQ (SBA): Systematic Delirium Cause Assessment