Particularly in older patients with baseline cognitive impairment, the simplest things can make a huge difference.
Constipation, and impaction can cause delirium, and are common in the hospital where normal diets and activities are disrupted.
The explanation may relate to aromatic amines and glutamate in the brainstem or it may be simply wanting to use the bathroom without being able to get there. Or it could be an inability to tell someone what is wrong.
Remember that a small or liquid BM can be passed around an impaction, so don't be fooled. |
Review nurses' BM records, check rectum, get KUB X-ray if in doubt. |
| In the same vein, delirium may reflect conditions like congestive heart failure, even when not obvious (rales, tachypnea) or associated with hypoxemia.
Half of the myocardial infarctions in the elderly are painless.
If you have been hydrating the patient or giving blood products, CHF should be considered. |
Get a chest X-ray and EKG in selected cases. |
