有關譫妄delirium的敘述下列何者正確

Presentation of Case

An 86-year-old man, previously healthy, presented to the emergency department (ED) at theis hospital because of consciousness disturbance, slurred speech, disorientation and tremor of the bilateral lower extremities (paroxysmal, every 10-20 seconds) for 1 day. He had received a diagnosed of benign prostatic hyperplasia, for which he underwent surgical intervention 2 months prior to this admission. Bloody urine and dysuria developed after the operation, associated with urinary frequency and urgency. One month prior to this admission, he stumbled when walking to toilet, resulting in fracture of the right femoral neck. Open reduction internal fixation (ORIF) was performed and he was successfully discharged. But the patient was found to have rapid functional decline in recent days, with disorientation and involuntary limbs movement. For this reason, he was brought to our ED.

On examination, the vital signs were normal but the patient had fluctuation in consciousness with disorientation to time, people and place. No motor weakness was noted. Brain MRI showed no intracranial hemorrhage. An electroencephalography (EEG) disclosed diffuse cortical dysfunction without epilepsy wave. Laboratory exam showed a white-cell count of 9520, pyuria ( WBC>100/HPF) and bacteruria (4+). A diagnosis of urinary tract infection was made and cefuroxime was administered, which was later changed to ceftazidime when a urine culture grew Morganella moarganii that was resistant to cefuroxime. During the hospital stay, tremor of the bilateral lower limbs tremor improved gradually, but fluctuation in mental function persisted for several days,

After the patient completed antibiotic treatment, delirium at night with weight loss still presented. The arterial blood gas showed metabolic alkalosis, while blood tests for electrolytes, NH3, and tumor markers were all within normal limits. Intravenous fluid supplement was continued until improvement of metabolic alkalosis and correction of volume depletion was observed. There was no hydronephrosis or malignancy by a series of imaging examinations. He underwent intermittent bladder irrigation per urologist��s suggestion. After a prolonged hospital stay, the delirium finally improved and he was safely discharged home.

Hemogram at ED

WBC
K/�gL

RBC
M/�gL

Hb
g/dL

Hct
%

MCV
fL

PLT
K/�gL

ALT
U/L

BUN
mg/dL

CRE
mg/dL

Na
mmol/L

K
mmol/L

CRP
mg/dL

12.45

4.00

11.4

34.5

86.3

276

16

17.6

0.6

135

5.2

0.96

Urine analysis at ED

Sp.Gr.

pH

Protein
mg/dL

Glu
mg/dL

Ketone
mg/dL

OB

Bil
mg/dL

Uro Bil
mg/dL

RBC
/HPF

WBC
/HPF

Cast

Crystal

1.017

7.0

0.7(1+)

-

-

+

-

normal

10-20

>100

-

-

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��ij�\Ū���m:

  1. Inouye SK: Delirium in older persons. N Engl J Med 2006; 354: 1157-65
  2. Cole MG: Delirium in elderly patients.Am J Geriatr Psychiatry 2004; 12: 7-21
  3. Meagher DJ: Delirium: optimising management. BMJ 2001; 322: 144-9
  4. Fong TG, Tulebaev SR, Inouye SK:Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol 2009; 5: 210-20

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