Delirium is a change in mental status. Delirium is marked by extreme, fluctuating changes, including:
Changes in perception and sensation
Difficulties with ability to:
FocusSustain and shift attentionThink and reason rationallyFunction normallyCommunicate clearly
Hundreds of underlying causes can result in delirium. Some of the most common causes include:
Serious medical condition such as a brain tumor,
or high blood sugar levels
Serious infections, such as meningitis, pneumonia,
and urinary tract infections
Toxic effects of medicationsInjury such as severe head injury,
broken bone, and severe pain
Withdrawal from alcohol or drug abuseToxins
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Factors that may increase your risk of developing delirium include: Terminal illness, especially just before death
Serious illness, such as
AIDSIncreased ageSevere sleep deprivation
Central nervous system problems such as
dementiaSurgeryHospitalizationVisual or hearing impairmentImmobilityDehydrationSevere
constipationMemory impairmentDeficiency in certain vitamins
Symptoms usually come on quickly and can last for days, weeks, or longer. They also vary in severity depending on the cause. Symptoms are often worse at night and may include: Inability to pay attentionConfusionMemory problemsLanguage disturbances
Disorientation, especially about:
Time of dayWhere one isWho one is
Severe symptoms include: Misinterpretations—for example, thinking a doctor who is trying to help you is trying to hurt youIllusions—for example, thinking someone is someone elseHallucinations—seeing, hearing, or feeling things that are not thereEmotional disturbances—for example, suddenly becoming angry, fearful, or withdrawn for no apparent reason
You will be asked about your symptoms and medical history. A physical exam will be done. The doctor will ask specific questions about: Present injury or illnessUse of medications or illicit drugsTime when mental state changedHow and how fast the mental state changed
The diagnosis will be made based on what the doctor finds during the exam. To determine a cause your doctor may need to run several tests:
Blood tests Urine testsLumbar punctureKidney and liver function tests
Thyroid function tests
Images of internal organs may also help to determine a cause. Images may be taken with: Chest x-rayCT scanMRI scan
Electrical activity of the heart and brain can be tested with electrocardiogram (EKG) and electroencephalogram (EEG).
Delirium is first treated by identifying and treating the underlying cause. Then, symptoms are treated through medication, psychological management, and environmental and supportive interventions.
Treatments may include:
Drugs used to treat symptoms of delirium include: High-potency antipsychotic medicationsBenzodiazepines—used to treat delirium caused by alcohol withdrawalCholinergic medications—used to treat delirium caused by anticholinergic medications, which are used to treat stomach cramps and spasms in the intestines and bladder, among other conditionsVitamins—given if the delirium is caused by low levels of vitamins
If you are taking medication that is worsening your confusion, you may be asked to stop these.
Psychological therapy may help you: Feel safer and more comfortableImprove the ability to functionCalm down and feel less
This type of treatment can be done by doctors, nurses, or caretakers. It can help you readjust to your surroundings and reduce anxiety. Examples of this intervention include: Placing a clock and calendar in your room.Darkening the room at night and providing natural light during the daytime hours.Maintaining a quiet, noise-free room.Using earplugs and/or eye shades during sleep to help reduce night noise.Reminding you often of the day and time, where you are, and why you are there.Placing familiar objects around you, such as family photographs or objects from home.
A number of steps have been shown to help prevent delirium in hospitalized patients at risk for delirium. These steps include: Using memory orientation aidsListening to relaxation tapesDoing light exercise—when possible and if advised by your doctorUsing vision and hearing aids when necessary
Drinking plenty of fluids to prevent
Delirium is difficult to prevent because it has so many causes and it can come on suddenly.
Delirium in hospitalized patients. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated September 15, 2014. Accessed September 17, 2014.
Gleason O. Delirium.
Am Fam Physician. 2003;67(5):1027-1034.
4/29/2016 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Litton E, Carnegie V, Elliott R, Webb SA. The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: a systematic review and meta-analysis. Crit Care Med. 2016;44(5):992-999.
Last reviewed August 2015 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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