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Delirium precipitated by urinary retention — SCE Acute Medicine MCQ

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HardMedicine in the ElderlyDelirium precipitated by urinary retentionSCE Acute Medicine

An 82-year-old woman with dementia is admitted with agitation and fluctuating drowsiness. She is afebrile, WCC normal and urine dip is negative. Bladder scan shows 890 mL residual volume and she has suprapubic tenderness. She was started on oxybutynin one week ago. What is the most appropriate next step in management?

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Correct answer: E — Catheterise the bladder and stop the anticholinergic precipitant

Urinary retention is a common reversible precipitant of delirium, and oxybutynin likely contributed through anticholinergic effects. Antibiotics are not indicated without evidence of infection. Antipsychotics do not treat the cause and may worsen adverse effects. A practical delirium approach is to search actively for pain, retention, constipation and medication triggers.

Reference: NICE CG103, NICE NG97, BNF