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Delirium from anticholinergic burden — SCE Acute Medicine MCQ

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ModerateMedicine in the ElderlyDelirium from anticholinergic burdenSCE Acute Medicine

An 86-year-old woman is admitted with acute confusion and visual hallucinations. She was started on oxybutynin and promethazine three days ago for urinary symptoms and sleep. Temperature is normal, urine dipstick has trace leucocytes and she is constipated with dry mouth and urinary retention. What is the most likely underlying cause?

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Correct answer: A — Anticholinergic medication burden causing delirium

The temporal link to oxybutynin and promethazine, urinary retention, constipation and dry mouth strongly supports anticholinergic delirium. A urine dipstick alone should not be over-interpreted in an older person without localising infection features. New primary psychosis is less likely at this age with acute onset and physical anticholinergic signs. The pearl is that medication review is a core delirium investigation.

Reference: https://www.nice.org.uk/guidance/cg103#acute-medicine-order-72-1