A reasonable diagnostic work-up to investigate the cause of a delirium would include:
- CBC, lytes, urea, creatinine, glucose
- Ca, Mg, PO4
- LFTs, TSH
- Cardiac biomarkers
- Chest x ray
- CT head if history of trauma, OR if substantially impaired consciousness OR if new focal neurologic findings OR if history is incomplete OR if there is no CLEAR alternative cause.
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Failure to find a cause does not mean that delirium is not present, but that the cause has not yet been determined.
Limits in the ED
The cause of a geriatric delirium cannot always be identified in the ED. On occasion, even after a thorough work-up in the ED, it may be necessary to admit the patient to the hospital with the diagnosis “Delirium Not Yet Diagnosed” It is rarely if ever safe to discharge a patient home with an acute mental status change without establishing a cause.