Commoner ICU causes

• Infection — including generalised sepsis, chest, cannula sites, urinary tract. Cerebral infection such as meningitis, encephalitis and malaria are relatively rare but should always be considered.

• Drug-related — (i) adverse reaction (particularly affecting the elderly), e.g. sedatives, analgesics, diuretics; (ii) withdrawal, e.g. sedatives, analgesics, ethanol; (iii) abuse, e.g. opiates, amphetamines, alcohol, hallucinogens.

• Metabolic — e.g. hypo- or hyperglycaemia, hypo- or hypernatraemia, hypercalcaemia, uraemia, hepatic encephalopathy, hypo- or hyperthermia, dehydration.

• Respiratory—infection, hypoxaemia, hypercapnia.

• Neurological — infection (meningo-encephalitis, malaria), post-head injury, space-occupying lesion (including haematoma), post-ictal, post-cardiac arrest.

• Cardiac — low output state, hypotension, endocarditis.

• Pain — full bladder (blocked Foley catheter), abdominal pain.

• Psychosis—'ICU psychosis', other psychiatric states.

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