The document discusses the etiology, predisposing factors, and management of delirium, highlighting various causes such as metabolic disorders, drug effects, infections, neurological issues, and postoperative complications. It emphasizes the importance of investigating underlying issues and providing symptomatic care while managing environmental factors to reduce confusion. Medication may be used cautiously in severe cases, with specific recommendations for antipsychotic and other supportive treatments.

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……