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Delirium

Alternate Names

  • acute confusion
  • acute delirium

Definition

Delirium can be caused by many medical conditions. It describes a seriously confused state of mind in a person. With delirium, the person may be unable to maintain attention, and thinking may be disorganized. The brain is unable to process information in the proper way.

What is going on in the body?

A person with delirium is unable to focus attention or reply correctly to questions. Delirium usually comes on quickly and needs to be assessed and treated immediately. It can usually be treated successfully once the cause is known. Delirium is more common in older people and may uncover dementia that escaped notice before.

Risks

What are the causes and risks of the condition?

Delirium can be caused by many things including:
  • abnormal sodium, chloride, ammonia, or other electrolyte levels in the blood
  • alcohol or drugs
  • head injury
  • liver or kidney failure, such as acute renal failure
  • low or high blood glucose
  • low oxygen levels in the blood
  • poisoning
  • seizures
  • severe dehydration
  • severe infections, such as a blood infection known as sepsis
  • withdrawal from drugs or alcohol

Prevention

What can be done to prevent the condition?

The best way to prevent delirium is to avoid illegal drugs and overuse of alcohol. It is important to seek proper treatment for all medical conditions. People with diabetes must monitor their blood glucose often to prevent very low or high levels. An attempt to eat healthy and stay healthy is important.

Diagnosed

How is the condition diagnosed?

Delirium requires immediate medical attention. A complete medical history and physical exam is necessary. Lab tests include drug and alcohol screening, blood glucose, and electrolytes, among others. A spinal tap or a cranial CT scan is often needed.

Long Term Effects

What are the long-term effects of the condition?

People with delirium may require a stay in the hospital. If the cause cannot be established or treated, they may have a poor outcome. There is a high mortality rate in hospitalized patients with delirium.

Other Risks

What are the risks to others?

People who are delirious can become very upset and even violent. Caregivers may be injured in the attempt to treat the individual.

Treatments

What are the treatments for the condition?

Treatment depends on the cause of the delirium. Symptoms can usually be reversed once the actual cause is named and treated. This is particularly true if the cause is low or high blood sugar. People with delirium are most comfortable in an environment that is:
  • quiet
  • calm
  • not brightly lighted
  • familiar
Restraints may be necessary if the person is highly agitated. Sometimes the agitation must also be treated with medicine. In this case, the smallest dose of medicine is used because the drugs themselves may worsen the confusion at the same time that they calm the agitation. Medicines are stopped as soon as possible so recovery from delirium can be assessed.

Side Effects

What are the side effects of the treatments?

Some psychoactive medicines can actually cause confusion, which is a symptom of delirium. Usually, few major side effects appear from treatment after the cause of delirium is identified, if psychoactive medicines are then tapered off.

After Treatment

What happens after treatment for the condition?

Recovery from delirium can be slow. The rate of recovery can depend on the cause. Elderly people often recover at a slower rate.

Monitor

How is the condition monitored?

The individual is monitored through blood chemistry studies and through physical exams. The specific monitoring will differ based on the cause of the delirium.

Sources

Merck Manual, Whitehouse Station, New Jersey, 1995-2000

On-line medical dictionary, 2000

Mayo Clinic, Geriatric Medicine, Topics in Geriatrics, Mayo Foundation for Medical Education and Research, 1996-2000

Taber's Cyclopedic Medical Dictionary, F.A. Davis Company, Philidelphia, PA

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