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Mr. B was previously healthy with only mild chronic obstructive pulmonary disease. His surgery went
well but was complicated by transient hypotension and excessive blood loss. He was extubated on
postoperative day 3. On postoperative day 4, his wife noted some confusion. The medical team did not
detect any abnormalities when they evaluated him. Today, postoperative day 5, he is more confused. He is
oriented only to person. He is unable to answer any minimally complicated questions.

Tasks:
1. What is the differential diagnosis of delirium and dementia?How would you frame the
differential?
Task 1 (5.0)Delirium and dementia are both syndromes of neurologic dysfunction. Both
present as a “change in mental status.” Their similarities end here. Whereas delirium is
acute, usually reversible and nearly always has an underlying, non-neurologic etiology,
dementia is chronic and seldom reversible.Because any illness can cause delirium in a
susceptible patient, the differential diagnosis of delirium is long and needs to consider a
broad range of illnesses, comorbidities, and medication effects. The differential diagnosis
of dementia is more finite; disorders have been listed in order of their approximate
 prevalence as etiologic factors.

2. At this point, what is the leading hypothesis, what are the active alternatives, and is there
a must not miss diagnosis? Given this differential diagnosis, what tests should be
ordered?
.
Task 2(5.0) Based on his history, Mr. B’s subacute mental status change appears to fulfill the
definition of delirium. The pivotal points are that his symptoms seem to vary, he is disoriented,
and he is inattentive. He certainly has many potential causes of delirium. Although Mr. B does
not have a history of alcohol abuse, alcohol withdrawal is always a possible diagnosis for acute
mental status changes in the hospital and should not be missed. Stroke and seizure, although
commonly considered in the differential diagnosis of mental status change, are rare causes of
delirium.
 Confusion Assessment Method
 Basic metabolic panel
 Pulse oximetry/ABG
 Urinalysis
 ECG,
 Review of medications