Delirium: Acute Confusional State
Delirium is an acute, fluctuating disturbance in attention and awareness. It is a medical emergency that indicates underlying systemic pathology.
Clinical Features
- Acute Onset: Changes develop over hours to days.
- Fluctuation: Symptoms wax and wane throughout the day (often worse at night—”sundowning”).
- Inattention: Difficulty focusing, shifting, or sustaining attention.
- Subtypes: Hyperactive (agitated, hallucinations), Hypoactive (lethargic, withdrawn—often missed), or Mixed.
Common Precipitating Factors (I WATCH DEATH)
| I – Infection | W – Withdrawal | A – Acute metabolic |
| T – Trauma | C – CNS pathology | H – Hypoxia |
| D – Deficiencies | E – Endocrine | A – Acute vascular |
| T – Toxins/Drugs | H – Heavy metals | — |
High-Yield Clinical Notes:
- Management: Focus on identifying and treating the underlying cause. Avoid unnecessary use of physical restraints or sedatives (especially benzodiazepines), which can worsen delirium.
- Non-Pharmacological: Early mobilization, sleep hygiene, reorientation (clocks/calendars), and maintaining hydration/nutrition.
- Delirium vs. Dementia: Dementia is chronic and progressive with stable awareness. Delirium is acute and fluctuating with impaired attention.