Abstract

CUNHA, Sara  and  PEREIRA, Carina. Delirium: when the guilty parties mix - case report. Rev Port Med Geral Fam [online]. 2020, vol.36, n.2, pp.169-174. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i2.12085.

Introduction: Delirium’s diagnosis may be complex due to its multiple etiologies and clinic presentations, occurring frequently due to organic disease’s decompensation. Knowing the main precipitant and predisposing factors is essential to achieve an early diagnosis, that provides an effective and fast approach and that minimizes its complications. Case report: Male patient, 72 years old, with a medical history of type 2 diabetes controlled with non-pharmacological measures (HbA1c 6,3%), dementia and benign prostatic hyperplasia. In March 2016 he starts to take darifenacin hydrobromide prescribed in the urology consultation for urinary urgency, which is suspended two months later due to behavioral changes and dry mouth. In the next week, because of an aggravation of his cognitive and behavioral status, the patient consults a neurologist which prescribes a food supplement. He’s then brought to his Primary Care Unit due to persistency of his complaints, pollakiuria, 12 kg weight loss, polyphagia and polydipsia (significant fruit and dishwashing detergent ingestion). He was disorientated and presented with a HI glycemia and ketonuria and proteinuria in the urine dipstick test. The patient was referred to the Emergency Room, where it was diagnosed an Hyperosmolar hyperglycemic state (HbA1c 12,3%), hypernatremia and acute renal failure. One month later, in the Primary Care reevaluation consultation, he was asymptomatic and within his normal behavior, medicated with metformin 1000 mg once a day and sitagliptin 50 mg twice-daily. Comment: Pre-existing cognitive impairment and male gender are some of the factors that predispose more frequently to delirium. In this case report, the introduction of new drugs and the decompensated diabetes mellitus might have contributed to the observed behavioral alterations. Elderly’s specificities, particularly its pluripathology and poliypragmasia are frequently confounding factors when facing a change in the clinical condition.

Keywords : dementia; delirium; diabetes mellitus type 2; primary health care.

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