EP.TH.104An interesting case of Post-ITU delirium
Abstract A 75-year old golf-player underwent an open radical cystectomy for a grade 3 bladder carcinoma. His medical history was unremarkable. Post-operatively, he was admitted to the ITU for observation and transferred to the ward after 3 days. On the 5th day post-op, he developed sudden SOB, tachypnoea and hypotension. Blood gas analysis revealed T1 respiratory failure and lactate of 3.3. He was commenced on anticoagulants and a CTPA incidentally found multiple small pulmonary emboli- suspected to be chronic. He developed severe HAP and was transferred back to ITU. 10 days later after improvement he was stepped down. His oral intake had significantly reduced and his urine output was low. He was alert but ward nurses found him to be vacant and significantly confused after his second step down. A CXR was unremarkable. He reported hallucinations and was struggling with his memory. A week later, he was transferred to a community hospital for rehabilitation as his delirium was improving. In the community, he experienced ongoing confusion and hallucinations. Nurses noted hematochezia and jaundice and he was re-admitted with abdominal pain and pyrexia. His LFTs were severely deranged and he was initiated on antibiotics for possible cholangitis. USS abdomen, CT and MRCP revealed no obvious cause of obstruction. A probable diagnosis of viral hepatitis was made by the Gastroenterologist which spontaneously resolved. CT head for confusion screen revealed right frontal lobe ischaemia with severe gliosis- possibly post-operative. The psychiatric team reviewed the patient and he was diagnosed with post-ITU delirium.