- Hypoxia
- Pneumonia
- Dehydration with elevated BUN/creatinine
- Hyponatremia
- Constipation
- Vitamin B12 deficiency
- Opiates
- Benzodiazepenes
All of the above could be contributing to his delirium and need to be corrected or addressed as best as possible.
Delirium is common in the last days of life, when death is imminent. Therefore, decisions regarding the extent of work-up and treatment of underlying causes of delirium must take place in the context of overall goals of care.
For Mr. M, treatment of potential underlying causes of delirium could include the following:
- Treatment of pneumonia (unless goals of care are dictate otherwise)
- Oxygen supplementation
- Adjustment of medication for constipation
- Correction of dehydration and hyponatremia with fluids
- Vitamin B12 supplementation