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ICU Delirium Reversible Causes — FRCA Final MCQ

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EasyIntensive Care MedicineICU Delirium Reversible CausesFRCA Final

A 55-year-old man on the ICU develops new acute confusion (CAM-ICU positive) on day 4. He was previously alert and oriented. Before attributing this to ICU delirium, which reversible causes must be systematically excluded?

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Correct answer: E — Infection, metabolic disturbance, drugs (sedatives, opioids, steroids, anticholinergics), pain, constipation, urinary retention, hypoxia, and intracranial pathology

New confusion in ICU requires systematic exclusion of reversible causes before attributing to ICU delirium. The mnemonic 'THINK' helps: Toxic situations (CHF, shock, dehydration, drug toxicity), Hypoxia, Infection/sepsis (including UTI, line infection), Nonpharmacological interventions needed (hearing aids, glasses, reorientation), K+ and other electrolyte abnormalities. Additional causes: urinary retention, constipation, pain, alcohol/benzodiazepine withdrawal, intracranial pathology (stroke, seizure, SDH), and drug effects (opioids, anticholinergics, corticosteroids).

Reference: ICS – 2023 – Delirium in critical care; NICE – 2019 – CG103 Delirium