Delirium is a clinical state characterized by an acute change in a person’s mental status. It usually comes on quickly, over hours or days. It 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 (eg,
or high blood sugar levels)
Serious illness (eg,
severe head injury
urinary tract infections
drug abuseWithdrawal from alcohol or drug abuseToxic effects of medicinesToxinsSleep deprivation
Just one of many potential causes of delirium.
Copyright © Nucleus Medical Media, Inc.
These factors increase your chance of developing delirium:
Having a terminal illness (eg, cancer), especially just prior to death
Having a serious illness (eg,
Being of an advanced ageBeing severely sleep deprived
Having a severe
Having central nervous system problems (eg,
, or tumors)
Visually or hearing impairedImmobileDehydratedConstipatedMemory impairedDeficient in vitamins
Symptoms usually come on quickly. They can vary in severity, depending on the underlying cause. They can last for days, weeks, or longer. Symptoms are often worse at night and may include:
Inability to pay attentionConfusionMemory problemsLanguage disturbances
Disorientation, especially in regard to:
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or feeling things that are not thereEmotional disturbances—for example, suddenly becoming very angry, fearful, or withdrawn for no apparent reason
The doctor will ask about your symptoms and medical history. She will also do a physical exam. The doctor will ask specific questions about:
Present injury or illnessUse of medicines or illicit drugsTime when mental state changedHow and how fast the mental state changed
There are many tests that may be used to help diagnose delirium. Depending on the specific case, any or all of these tests may be done, including:
Blood electrolytes—to measure levels of
calciumKidney and liver function testsBlood glucose levelsComplete blood count
Blood vitamin levels—such as
thiamineThyroid function testsBlood cultures—to look for signs of infectionSpinal tap
—to look for signs of infection, inflammation, nervous system, injury, and/or cancer
Urine examination and culture—to look for signs of infectionArterial blood gas—to check oxygen levels in the bloodToxicology testing—to search for any illicit drugs in the bodyBlood levels of medicinesChest x-ray
—a test that uses radiation to take a picture of structures inside the chest to look for signs of pneumonia
(ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
—a type of x-ray that uses a computer to make pictures of structures inside the head
—a test that uses magnetic waves to make pictures of structures inside the head
(EEG)—a test that record's the brain's activity by measuring electrical currents through the brain
Delirium is first treated by identifying and treating the underlying cause. Then, symptoms are treated through medicine, psychological management, and environmental and supportive intervention.
Treatments may include:
Drugs used to treat symptoms of delirium include:
High potency antipsychotic medicines (eg,
Benzodiazepines—used to treat delirium caused by alcohol withdrawalCholinergic medicines—used to treat delirium caused by anticholinergic medicines, which are used to treat stomach cramps and spasms in the intestines and bladder, among other treatmentsVitamins—given if the delirium is caused by a deficiency
If you are taking medicines that are worsening your confusion, then your doctor may stop these.
This type of therapy involves helping the patient to:
Feel more safe and comfortableIdentify the cause of the deliriumImprove the ability to function
Calm down and feel less
This type of treatment can be done by doctors, nurses, or caretakers. It is aimed at reorienting you to the surroundings and reducing anxiety. It can involve actions, such as:
Placing a clock and calendar in your roomDarkening the room at night and providing natural light during the day time hoursMaintaining a quiet, noise-free roomReminding you often of the day and time, where you are, and why you are therePlacing familiar objects around you (eg, 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 very light exercise (when possible and if recommended by your doctor)Using 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.
The Merck Manual of Medical Information
. New York, NY: Pocket; 2000.
Last reviewed December 2011 by J. Thomas Megerian, MD, PhD, FAAP
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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