Stepwise Evaluation of a Pt with Delirium | |||
| Initial Evaluation | |||
|---|---|---|---|
| History with special attention to medications (including over-the-counter and herbals) | |||
| General physical examination and neurologic examination | |||
| Complete blood count | |||
| Electrolyte panel including calcium, magnesium, phosphorus | |||
| Liver function tests, including albumin | |||
| Renal function tests | |||
| First-Tier Further Evaluation Guided by Initial Evaluation | |||
| Systemic infection screen | |||
| |||
| Electrocardiogram | |||
| Arterial blood gas | |||
| Serum and/or urine toxicology screen (perform earlier in young persons) | |||
| Brain imaging with MRI with diffusion and gadolinium (preferred) or CT | |||
| Suspected CNS infection or other inflammatory disorder: lumbar puncture after brain imaging | |||
| Suspected seizure-related etiology: electroencephalogram (EEG) (if high suspicion, should be performed immediately) | |||
| Second-Tier Further Evaluation | |||
| Vitamin levels: B12, folate, thiamine | |||
| Endocrinologic laboratories: thyroid-stimulating hormone (TSH) and free T4; cortisol | |||
| Serum ammonia | |||
| Sedimentation rate | |||
| Autoimmune serologies: antinuclear antibodies (ANA), complement levels; p-ANCA, c-ANCA, consider paraneoplastic/autoimmune encephalitis serologies | |||
| Infectious serologies: rapid plasmin reagin (RPR); fungal and viral serologies if high suspicion; HIV antibody | |||
| Lumbar puncture (if not already performed) | |||
| Brain MRI with and without gadolinium (if not already performed) | |||