Question 240

Question:

An 80-year-old man is admitted to the hospital for treatment of a burn that covers 20% of his total body surface area. Two days after admission, his behavior has changed. He accuses the staff of torturing him. He cannot recall why he was admitted to the hospital and is not oriented to date and place. His wife says he was “fine” before the burn. Which of the following is the most likely diagnosis?

Correct Answer: B.  Delirium

This man is exhibiting the classic signs of (B) delirium: an acute change in mental status, inattention, disorganized thinking, and a fluctuating level of awareness. Delirium can be caused by any of the following in the mnemonic P. DIMM WIT: Postoperative state, Dehydration/malnutrition, Infection, Medications, Metals (heavy metals exposure), Withdrawal from alcohol/drugs, Inflammation, and, as in this case, Trauma/Burns.
The acute onset of this change in mental status makes (B) delirium a much more likely diagnosis than (A) adjustment disorder, (C) Paranoid personality disorder, (D) Schizophrenia, or (E) Alzheimer’s dementia.