Internal Medicine

Answer 3 Calf vein thrombosis. Delirium is common in elderly patients undergoing hip fracture surgery, and levels of alertness wax and wane, ranging from somnolence to agitated paranoia.4 Delirium incidence increases with advanced age and is more likely to occur in patients with underlying dementia or neurologic disease. Common causes of postoperative delirium include anesthesia, antiemetics, narcotics, electrolyte derangements (especially hyponatremia), infections, hypoxia, and acid-base disturbances. Isolated calf vein thrombosis would not be expected to cause delirium; however, an above-knee thrombosis with significant pulmonary embolism and hypoxia can present as acute delirium after hip surgery. REFERENCE 4. Parikh SS, Chung F. Postoperative delirium in the elderly. Anesth Analg 1995;80:1223–32. Click here to return to the questions

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