رجل عمره ٨٢ سنة بعد عملية كسر في الورك بيومين، يأخذ مورفين للألم، ولم يُخرج من ٣ أيام. كان واعياً ومدركاً قبل العملية. صار فجأة مشوشاً، لا يركز، يسحب القسطرة، ويتقلب وعيه خلال اليوم. الحرارة ٣٧٫٦. ما الأرجح؟

An 82-year-old man two days after hip fracture surgery is on morphine and has not opened his bowels for 3 days. He was alert and oriented before surgery. He is now suddenly confused, inattentive, pulling at his catheter, with fluctuating awareness through the day. T 37.6 °C. What is most likely?

1. Severe chronic depression
2. Acute delirium
3. A new personality after anaesthesia
4. Sudden-onset Alzheimer’s dementia

Answer: B) Acute delirium. Delirium starts suddenly and fluctuates with inattention, from many causes: pain, infection, drugs, hypoxia, dehydration, urinary retention. Dementia develops over months to years.