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Delirium with acute kidney injury — DGM MCQ

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HardDeliriumDelirium with acute kidney injuryDGM

An 90-year-old man with chronic kidney disease is reviewed for confusion after 4 days of diarrhoea. He is drowsy, respiratory rate is 24/min, creatinine has risen from 120 to 260 micromol/L and venous bicarbonate is 15 mmol/L. He takes metformin, ramipril and furosemide. What is the most likely diagnosis?

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Correct answer: B — Acute delirium due to dehydration and acute kidney injury

The acute altered attention with dehydration, AKI and metabolic acidosis is most consistent with delirium from acute medical illness. Lewy body dementia causes fluctuating cognition but is not usually linked to this rapid biochemical deterioration. Older adults may present with confusion as the dominant feature of renal or metabolic illness.

Reference: NICE CG103; NICE NG148