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Description : delirium CASE

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Published on : Nov 01, 2025 | Views : 217 | Downloads : 0

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CASE 1 75 year old Female, Came with complaints on chest pain – retrosternal, radiating to left arm Associated with breathlessness, palpitations No known comorbidities No history of active bleeding/ recent surgery/ head trauma O/E – Pulse: 38/min ; BP: 110/70 mmHg Pallor + Systemic examination (CVS, CNS, RS, PA ) - WNL
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ECG ECG was suggestive of ST elevation in III and aVF with reciprocal ST depression in I, aVL, V2-V6; and 3rd degree AV Block
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COURSE OF PATIENT IN HOSPITAL Loading dose of Aspirin 325mg, Clopidogrel 300mg, Atorvastatin 80mg given Patient of shifted to ICU and routine investigations sent Injection Streptokinase 1.5mU in 100cc NS given to patient over 45 minutes Chest pain reduced Next morning, Day 2 of admission – Patient developed altered behaviour with irritability, irrelevant talk CAUSE ?
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INVESTIGATIONS CT Brain (Plain) - NAD
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TREATMENT 2 PCV transfusion Tab Aspirin 75mg OD Tab Clopidogrel 75mg OD Tab Stator 40mg HS Patient showed clinical improvement in 2 days and was shifted to ward for further management of ACS
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SUMMARY CAUSE of DELIRIUM : Anemia RISK FACTORS : Old Age Major cardiac disease ICU stay TREATMENT : Blood transfusion
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Case 2 50 year old Male Came with complaints of irrelevant talk, violent behaviour, fluctuating sensorium, not recognizing surrounding, sweating Histort of alcohol abuse since 10 years, last drink 4 days ago O/E – Tremors + Pulse -112/min, BP – 110/70mmHg CNS – conscious and not oriented Rest systemic examination - NAD
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INVESTIGATIONS – day 1 CT Brain (Plain) - NAD
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TREAtMENT Injection lorazepam 4mg iv TDS for 3 days followed by tapering doses Injection Haloperidol 2.5mg SOS Injection optineuron IV Hydration Patient showed improvement in 3 days of treatment with normalization of Sr Na, urea and creatine
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SUMMARY CAUSE of DELIRIUM : Alcohol withdrawl Dyselectrolemia Increased urea and creatine RISK FACTORS : Alcohol abuse Dehydration TREATMENT : Injection lorazepam Hydration
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CASE 3 68 year old Female, Came with complaints on 3-4 episode of loose stools/day breatlessness on exertion, palpitations Associated with giddiness, sweating Known case of psychiatric illness on tab Na valproate 200mg OD O/E – Pulse: 168/min ; BP: 90/70 mmHg Systemic examination (CVS, CNS, RS, PA ) - WNL
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INVESTIGATIONS ECG – Atrial fibrillation with FVR 2D Echo – EF – 45%, LA clot, Grade 2 LV systolic dysfunction CT Brain (Plain) - NAD
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COURSE OF PATIENT IN HOSPITAL Injection Diltiazem 12.5 mg iv given twice and Tab Diltiazem 30mg TDS continued Injection clexane 0.6cc s/c started and bridged with Tab warfarin 5mg OD Patient was shifted to ward after 5 days of ICU stay She still had persistent 2-3 episodes of loose stools and breathlessness On Day 7 of admission – Patient developed fluctuating orientation with irritability, irrelevant talk
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FURTHER INVESTIGATIONS Repeat CT Brain plain – NAD Thyroid function test :
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TREATMENT Tab Neomerconazole 5mg TDS started Tab Dilzem 30mg TDS continued Tab Warfarin 5mg OD continued Sensorium improved within a week of treatment initiation
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SUMMARY CAUSE of DELIRIUM : Hyperthyroidism RISK FACTORS : Old Age Prolonged hospital stay Pre existing psychiatric illness TREATMENT : Tab Neomerconazole
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Case 4 61 year old male patient, Came with complaints of breathlessness on exertion since past two years - gradually progressive and associated with excessive sweating, dizziness and retrosternal chest pain which was non radiating He was a known case of Hypertension since six years on regular medication. O/E – P-74/min, BP – 100/60mmHg Systemic examination (CVS, CNS, RS, PA ) – WNL
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Initial routine blood investigations – WNL 2D Echo – s/o Rheumatic valvular heart disease with severe mitral stenosis and severe atrial stenosis with severe pulmonary arterial hypertension and dilated right ventricle and atrium. Patient was subsequently posted for elective Double Valve Replacement and admitted in cardiac ICU Patient was operated after ten days of ICU stay. On post op day one, Patient developed symptoms of irrelevant talk, agitation, drowsiness with a fluctuating course.
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INVESTIGATIONS CT Brain (Plain) - NAD
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TREATMENT Intravenous antibiotics for active infection 0.45% NS for dyselectrolemia Antiplatelets and rate control drugs were continued for cardiovascular disorder. Tab olazenpine 2.5 mg HS was given for three days and SOS if agitation. Five days after initiation of above treatment patient showed improvement in general condition along with laboratory parameters. Patient was shifted to general ward and discharged after two days.
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SUMMARY CAUSE of DELIRIUM : Dyselectrolemia RISK FACTORS : Infection Major cardiovascular surgery Old Age Prolonged ICU stay TREATMENT : 0.45 % NS
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CASE 5 77 year old Female, Came with complaints on multiple episode of loose stools with PR bleed breatlessness on exertion, easy fatiguability No known comorbidities O/E – Pulse: 78/min ; BP: 120/70 mmHg Systemic examination (CVS, CNS, RS, PA ) - WNL
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INVESTIGATIONS CT Brain (Plain) - NAD
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TREATMENT Patient was treated with PCV transfusions, intravenous antibiotics OGDscopy – s/o Forrest ulcer grade 3 CECT (A+P) – f/s/o neoplastic etiology On day 6 of admission – patient had developed intermittent irritability, fluctuating orientation, sleep disturbances, irrelevant talk
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SUMMARY CAUSE of DELIRIUM : Infection RISK FACTORS : Anemia Major medical disease Old Age Prolonged hospital stay TREATMENT : Intravenous antibiotics