Let’s talk about delirium — that delightful clinical scenario where your calm 70-year-old patient suddenly believes the IV stand is plotting against them.
I’ve seen post-op grannies at my hospital trying to escape the ward, febrile uncles arguing with ECG leads, and ICU patients talking to invisible cousins. If you’ve worked even a day in general medicine, you know delirium is real, rampant, and sneaky.
So how do you decode it before you order a million-dollar MRI? You PINCH ME.
No, seriously — that’s the mnemonic. 👇
Mnemonic Table: Causes of Delirium — “PINCH ME”
| Letter | Cause | Explanation |
|---|---|---|
| P | Pain | Especially in elderly or post-op patients. Even a minor fracture can trigger confusion. 😖 |
| I | Infection | UTI in the elderly = mental mayhem. Pneumonia and sepsis also common culprits. 🦠 |
| N | Nutrition | B12 deficiency, thiamine deficiency (think Wernicke’s). Brain needs more than biryani. 🍛🧠 |
| C | Constipation | You laugh — but severe fecal loading is a legit cause. Gut-brain axis revenge. 🚽 |
| H | Hydration | Dehydration shrinks more than skin — it shrivels cognition too. 🥵💧 |
| M | Medications | Anticholinergics, benzodiazepines, opiates — basically anything fun. 💊🚫 |
| E | Environment | ICU lights, new surroundings, sleep disruption — the brain hates jet lag. 🛏️🔦 |
🩺 My Take from Quetta
At Sheikh Khalifa Bin Zayed Hospital, Quetta, I’ve seen more delirium cases triggered by poor hydration and infections than you’d believe. Especially in older adults, it’s often the “small things” that push the brain over the edge. A missed water round, untreated constipation, or a hidden UTI — and boom, chaos.
In fact, I always say: “Before CT-brain, CT-bladder and CT-bowels.” 💡
🧠 Clinical Tip
If you’re ever stuck, don’t start with MRI. Start with PINCH ME — it’s cheaper, faster, and less likely to uncover a ‘clinically insignificant incidentaloma’ that gives everyone anxiety. 😵💫
HAPPY LEARNING, folks! 🙂
Signing off,
Dr. Aurangzaib Qambrani
(MBBS, PLAB, MRCP-UK 1)
Sheikh Khalifa Bin Zayed Hospital Quetta
