Delirium Etiologies

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)

Leave a Comment