Confusional States And Delirium

Of all acute medical admissions, 5-10% present with a confused verbal response, i.e. disorientation in time and/or place. Most patients are easily distracted, have slowed thought processes and a limited concentration span. Some may lose interest in the examination to the point of drifting off to sleep.

Perceptual disorders (illusions and hallucinations) may accompany the confused state -delirium. This is often associated with withdrawal and lack of awareness or with restlessness and hyperactivity.

Primary neurological disorders contribute to only 10% of those patients presenting with an acute confusional state. In the elderly, postoperative disorientation is particularly common and multiple factors probably apply; in these patients the prognosis is good.

DIAGNOSTIC APPROACH

urine chest X-ray blood cultures urea and electrolytes blood glucose blood gases/PH liver function tests serum calcium and phosphate magnesium amylase porphyrins

[N.B. A minor infection or change in environment superimposed on Alzheimer's disease may result in acute disorientation]

Nutritional disorders

- thiamine

- folic acid

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