DELERIUM

• There are a multitude of causes for acute confusional state - important ones to consider are hypoxia, hypoglycaemia, electrolyte disturbance, drug toxicity, drug withdrawal, infection and space-occupying brain lesions.

CAUSES (Some)

• Infection

• LRTI
• UTI
• Meningitis/Encephalitis
• Cerebral abscess

• Metabolic

• Hypoxia
• Hypercarbia
• Hypothermia/Hyperthermia
• Hypoglycaemia
• Electrolyte disturbace
• Renal failure
• Liver failure
• Vitamin deficiency/Wernicke's encephalopathy

• Toxic/Drugs

• CNS depressants
• Psychotropics
• Anticholinergics

• Space occupying lesions

MINIMAL SCREENING INVESTIGATIONS

BSL
MSU
WCC
EUC

CXR (if symptoms of infection or evidence of hypoxia)
CT Brain (if history of head trauma, focal neurology or cause not established)

See Screening for Organic Illness in the Disturbed Patient

MANAGEMENT

• Treat cause
• Admit patient medically