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Delirium in hospital

Identifier

006436

Type of Spiritual Experience

Vision
Hallucination

Number of hallucinations: 90

Background

Azotemia is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood. It is largely related to insufficient filtering of blood by the kidneys and thus is an indicator of kidney disease.

Hyperamylasemia describes a higher than normal concentration of amylase in the blood and may reflect one of several medical conditions, including acute inflammation of the pancreas, but also perforated peptic ulcer, torsion of an ovarian cyst, strangulation ileus, mesenteric ischemia, macroamylasemia and mumps! Amylase may be measured in other body fluids, including urine and peritoneal fluid.

Hyperbilirubinemia can be an indicator of liver disease.

A description of the experience

Predisposing factors for delirium in the surgical intensive care unit - Aldemir M, Ozen S Kara IH, Sir A Baç B.; Department of General Surgery, Dicle University, Faculty of Medicine, Diyarbakir, Turkey.

BACKGROUND:  Delirium is a sign of deterioration in the homeostasis and physical status of the patient. The objective of our study was to investigate the predisposing factors for delirium in a surgical intensive care unit (ICU) setting.

METHOD:  Between January 1996 and 1997, we screened prospectively 818 patients who were consecutive applicants to the general surgery service of Dicle-University Hospital and had been kept in the ICU for delirium.

All patients were hospitalized either for elective or emergency services and were treated either with medication and/or surgery.

Suspected cases of delirium were identified during daily interviews.

The patients who had changes in the status of consciousness (n = 150) were consulted with an experienced consultation-liaison psychiatrist. The diagnosis of delirium was based on Diagnostic and Statistical Manual of Mental Disorders (revised third edition) criteria and established through psychiatric interviews. Patients were divided into two groups: the "delirious group" (DG) (n = 90) and the "non-delirious group" (NDG) (n = 728). During delirium, all abnormal findings related to physical conditions, laboratory features, and additional diseases were evaluated as probable risk factors of delirium.

RESULTS:   Logistic regression was used to explore the associations between probable risk factors and delirium. Delirium was not correlated with conditions such as

  • Hypertension
  • hypo/hyperpotassemia
  • hypernatremia
  • hypoalbuminemia
  • hypo/hyperglycemia
  • cardiac disease
  • emergency admission
  • age
  • length of stay in the ICU
  • length of stay in hospital
  • and gender.

 It was determined that conditions such as 

  • respiratory diseases (odds ratio [OR] = 30.6, 95% confidence interval [CI] = 9.5-98.4),
  • infections (OR = 18.0, 95% CI = 3.5-90.8),
  • fever (OR = 14.3, 95% CI = 4.1-49.3),
  • anemia (OR = 5.4, 95% CI = 1.6-17.8),
  • hypotension (OR = 19.8, 95% CI = 5.3-74.3),
  • hypocalcemia (OR = 30.9, 95% CI = 5.8-163.2),
  • hyponatremia (OR = 8.2, 95% CI = 2.5-26.4)
  • azotemia (OR = 4.6, 95% CI = 1.4-15.6),
  • elevated liver enzymes (OR = 6.3, 95% CI = 1.2-32.2),
  • hyperamylasemia (OR = 43.4, 95% CI = 4.2-442.7),
  • hyperbilirubinemia (OR = 8.7, 95% CI = 2.0-37.7)
  • and metabolic acidosis (OR = 4.5, 95% CI = 1.1-17.7)

were predicting factors for delirium.

CONCLUSION:  We determined that conditions such as respiratory diseases, infections, fever, anemia, hypotension, hypocalcemia, hyponatremia, azotemia, elevated liver enzymes, hyperamylasemia, hyperbilirubinemia and metabolic acidosis were predicting factors for delirium.

The source of the experience

PubMed

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Activities and commonsteps

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References