Acute change in mental status that fluctuates, abnormal attention, disorganized thinking and altered LOC
- Three criteria (A-C) are common to delirium caused by (1) a general medical condition, (2) substance intoxication, and (3) multiple etiologies:
- Disturbance of consciousness (ie, reduced clarity of awareness of the environment) occurs, with reduced ability to focus, sustain, or shift attention.
- Change in cognition (eg, memory deficit, disorientation, language disturbance, perceptual disturbance) occurs that is not better accounted for by a preexisting, established, or evolving dementia.
- The disturbance develops over a short period (usually hours to days) and tends to fluctuate during the course of the day.
CNS disorder
- Seizure
- Migraine
- Head trauma
- Concussion
- Contusion
- Laceration
- Brain tumor 10 or 20
- Infection – meningitis or encephalitis
- Viral – enterovirus
- Bacterial – pneumococcal, meningococcal
- Spirochette – syphilis
- Vascular
- Arterial – transient ischemia, non-hemorrhagic stroke, hemorrhagic stroke, embolic stroke
- Venous – subdural hematoma, thrombosis
Metabolic disorders and Endocrinopathies
- Electrolyte abnormalities
- Potassium, Chloride, Magnesium, Manganese
- Fluid abnormalities
- Dehydration
- Intoxication
- Diabetes (hypoglycemia, hyperglycemia, insulin resistance)
- Adrenal abnormality
- Thyroid abnormality
- Parathyroid abnormality
Neoplasm
- Primary brain
- Metastases
- Paraneoplastic syndrome
Miscellaneous
- Intensive care unit psychosis
- Sleep deprivation
Systemic illness
- Cardiac
- Cardiac failure (CHF)
- Arrhythmia
- Myocardial infarction
- Cardiac assist device
- Cardiac surgery
- Pulmonary
- COPD
- Hypoxia
- SIADH
- Acid base disturbance
- Hematological
- Anemia
- Leukemia
- Blood dyscrasia
- Stem cell transplant
- Renal
- Renal failure
- Uremia
- SIADH
- Hepatic
- Hepatitis
- Cirrhosis
- Hepatic failure
- Infection (sepsis, abscess)
- Viral: enterovirus
- Bacterial: pneumonia (S. pneumoniae, H. influenzae, K. pneumoniae), UTI (E. coli)
- Mycotic: aspergillosis
- Spirochette: Lyme disease, syphilis
- Nutritional deficiency
Medications and Toxins (use, intoxication, withdrawal)
- OTC (i.e. aspirin, Tylenol, ibuprofen, antihistamines, decongestants)
- Herbals (i.e. jimsonweed, oleander, foxglove, hemlock, dieffenbachia, Amanita phalloides)
- Heavy metals (i.e. , mercury, lead, arsenic, aluminum)
- Prescription medications
- Pain medication (i.e. postoperative meperidine or morphine; lidocaine; barbiturates)
- Anesthesia (i.e. ketamine)
- Cardiac medications (i.e. digitalis, procainamide – arrhythmias)
- Antihypertensives (i.e. methyldopa, reserpine)
- Steroids
- Antibiotics, antivirals and antifungals (i.e. amphotericin B, zalcitabine DDC, zidovudine AZT, pentamidine)
- Sedative-Hypnotics (i.e. LA benzo’s – diazepam, flurazepam)
- Histamine H2 antagonist (i.e. cimetidine)
- Antineoplastic agents
- Anticholinergic agents (i.e. Benadryl, TCA, diphenhydramine – insomnia)
- Antituberculous agents
- Antispasmotics (i.e. baclofen)
- Ephedrine
- Lithium
- Contrast media
- Colchicine (antigout)
- Indomethacin
- Levodopa
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Abuse (intoxication or withdrawal)
- Stimulants (i.e. crack/cocaine, amphetamines, methamphetamines)
- Opiates (i.e. heroin, methadone, morphine, demerol)
- Sedatives (i.e. EtOH, cannabinoids, marijuana, hashish)
- Organic molecules (i.e. pesticides, insecticides, solvents/volatiles, gasoline, glue, ethylene glycol)