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Delirium from hyponatraemia — DGM MCQ

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HardDeliriumDelirium from hyponatraemiaDGM

A 79-year-old woman develops confusion and unsteadiness after a chest infection. She is nauseated and more drowsy than usual. Serum sodium is 121 mmol/L; symptoms fluctuate during the day. Current medicines include sertraline, bendroflumethiazide and amoxicillin. What is the most likely diagnosis?

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Correct answer: B — Delirium precipitated by hyponatraemia

Acute fluctuating confusion with severe hyponatraemia indicates delirium precipitated by a metabolic disturbance. Alzheimer's disease and normal pressure hydrocephalus are chronic, BPPV does not cause low sodium, and temporal arteritis does not explain the fluctuation. Electrolyte disturbance is a reversible delirium cause and may be medication-related.

Reference: NICE CG103; BNF