Delirium is a change in mental status. It usually comes on quickly, over hours or days. 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 (eg,
or high blood sugar levels)
Serious infections (eg,
urinary tract infections
Toxic effects of medicinesInjury (eg,
severe head injury,
broken bone, or severe pain
drug abuseWithdrawal from alcohol or drug abuseToxins
Just one of many potential causes of delirium.
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These factors increase your chance of developing delirium: Terminal illness, especially just before death
Serious illness such as
AIDSAdvanced ageSevere sleep deprivation
Central nervous system problems such as
, tumors or
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or feeling things that are not thereEmotional disturbances—for example, suddenly becoming very angry, fearful, or withdrawn for no apparent reason
The doctor will ask about your symptoms and medical history. A physical exam will be done and the doctor will ask you questions. 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
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 such as:
Blood tests to:
Look for signs of infection
Examine electrolyte levels including
calciumDetermine oxygen levels in the bloodDetermine blood glucose levels
Determine Level of vitamins such as
thiamineAssess the level of medication in the bloodLook for toxins or illicit drugsKidney and liver function testsThyroid function testsSpinal tap
—to look for signs of infection, inflammation, injury, and/or cancer in the brain or spine
Urine examination and culture—to look for signs of infection
Images of internal organs may also help to determine a cause. Images may be taken with: Chest x-ray
to look for pneumonia
(ECG)—to examine the heart's electrical activity for evidence of heart disease
CT scanMRI scanElectroencephalogram
(EEG)—to look for evidence of seizures
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 medicinesBenzodiazepines—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 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 reducing 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 day time hours.Maintaining a quiet, noise-free room.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 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.
Last reviewed September 2013 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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