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Delirium due to urinary retention — SCE Acute Medicine MCQ

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ModerateMedicine in the elderlyDelirium due to urinary retentionSCE Acute Medicine

An 84-year-old man with dementia is admitted from home with agitation and visual hallucinations. He has urinary retention of 900 mL after a new anticholinergic bladder tablet was started. Temperature is 37.1°C, CRP is 8 mg/L and urine dipstick is negative. He has no focal neurology. What is the most likely diagnosis?

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Correct answer: E — Delirium precipitated by urinary retention and anticholinergic medication

Acute fluctuating confusion with hallucinations in an older adult is delirium until proved otherwise, and urinary retention plus anticholinergic medication are strong precipitants. A negative dipstick and low inflammatory markers make UTI less likely as the main driver. Dementia increases vulnerability but should not stop clinicians identifying reversible causes.

Reference: NICE CG103; NICE NG97