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1. DELIRIUM
ETIOLOGY &
PREDISPOSING FACTORS
INVESTIGATION &
TREATMENT

2. ETIOLOGY
• A) Metabolic disorders -
 Hypoglycemia,
 Hypoxia,
 Fluid & electrolyte disturbances,
 Dehydration
 Disturbances of Ca, Mg.

3.  Hyponatremia.
 Liver & kidney failure.
 Endocrinopathies (thyroid,
parathyroid, pituitary),
 Porphyria
 Thiamine def.

4. B) Drug related
• Sedative-hypnotics.
• Anticholinergics
• Antihistaminic drugs.
• Psychotropics.
• Anticonvulsants.
• Narcotic analgesics.
• Withdrawal syndromes.
• Delirium tremens.

5. • c) Infections
 Meningitis.
 Encephalitis,
 Brain abscess,
 Pneumonia
 Lyme disease.
 AIDS
 Septicemia

6. • D) Neurological
 Strokes,
 Epilepsy,-postictal
 Head injury,
 Hypertensive encephalopathy,
 Brain tumors,

7. • E) Postoperative
Specific surgeries.
anesthetic and other drug effects,
Electrolyte imbalances.
hypoxia and anemia,
fragmented sleep,
pain

8. • F) Miscellaneous
 Anemia
 Cerebral vasculitides.
 Paraneoplastic and limbic encephalitis.
 Trauma.
 Dehydration.
 Electrocution.
 attempted hanging

9. Predisposing factors
Advanced age.
Dementia.
Fluid and electrolyte disturbances
dehydration
Other metabolic disturbance.
 hepatic insufficiency.

10. contd..
cancer
Infections.
AIDS.
Malnutrition.
Cardiorespiratory failure.
Prior stroke.

11. contd…
Polypharmacy and use of analgesics,
psychoactive drugs, or anticholinergics.
Drug abuse, alcohol or sedative
dependency.
Sleep disturbance.

12.  Fever, hypothermia
Physical trauma or severe burns
Fractures
Male gender
Depression

13. Investigations
• Blood cell count
• Blood glucose
• Blood-urea, nitrogen, creatinine,
transaminase,ammonia levels.
• Thyroid fn tests.
• Chest x-rays
• EEG changes

15. contd…
• Arterial blood gas studies
• ECG
• Urine analysis.
• Lumbar puncture
• Neuroimaging

16. MANAGEMENT
I. finding the cause and
eliminating it
• with symptomatic measures involving
attention to fluid and electrolyte balance,
nutritional status, and early treatment of
infections.

17. II. environmental
interventions
• . Reduce unfamiliarity by providing a
calendar, a clock, family pictures, and
personal objects.
• Maintain a moderate sensory balance in the
patient by avoiding sensory overstimulation
or deprivation.

18. • Other environmental measures
:- include providing soft music and
warm baths, and allowing the patient to
take walks when possible.
• Proper communication and support.

19. • It is best to avoid the use of drugs in
confused patients because their effects
further cloud the clinical picture and
may worsen the delirium.

20. • MEDICATION is necessary if the
patient’s behavior is potentially
dangerous, interferes with medical care.
• Haloperidol (starting at 0.25 mg
daily) repeated every 30 minutes,
given (PO) or (IM), up to maximum
loading dose of 5 mg/day.

21. • The atypical antipsychotics
• risperidone, olanzapine, quetiapine,and
aripiprazole.
• Other medications, such as valproate,
donepezil, or ondansetron,may be
effective and safe in selected cases.

22. THANK YOU……