- Brain hemorrhage or infarction.
- Brain tumor.
- Low blood oxygen (hypoxemia).
- High blood carbondioxide (hypercapnia).
- Post-surgical complication.
- Antidepressant drugs.
- Anticonvulsant drugs.
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Anticancer drugs.
- LSD (lysergic acid diethylamide) and other hallucinogens.
- Ethanol (drinking alcohol).
- Opiates, including heroin and morphine.
- PCP (phencyclidine).
- Solvents, such as gasoline, kerosene, turpentine, benzene, and alcohols.
- Carbon monoxide.
- Refrigerants (Freon).
- Insecticides, such as Parathion and Sevin.
- Mushrooms, such as Amanita species.
- Plants such as jimsonweed (Datura stramonium) and morning glory (Ipomoea spp.)
- Animal venoms.
- Severe medical illness.
- Alcohol abuse.
- Diminished ADL (activity of daily living).
- Abnormal serum sodium.
- Male gender.
- Hearing impairment.
- Visual impairment.
- Acute myocardial events.
- Acute pulmonary events.
- Fluid and electrolyte disturbance (including dehydration).
- Drug withdrawal (sedatives, alcohol).
- Infection (especially respiratory, urinary).
- Medications (wide range, esp. psychoactive, anticholinergics and opioids).
- Uncontrolled pain.
- Urinary retention, faecal impaction.
- Indwelling devices (urinary catheters).
- Severe anemia.
- Use of restraints.
- Intracranial events (stroke, bleeding, infection).
- Changes in feeling (sensation) and perception.
- Changes in level of consciousness or awareness.
- Changes in movement (may be inactive or slow moving).
- Changes in sleep patterns, drowsiness.
- Disorientation about time or place.
- Unable to remember events.
- Inability to think or behave with purpose.
- Problems concentrating.
- Incoherent speech (speech that doesn't make sense).
- Distinguish among differential diagnostic possibilities; for patientswith features of delirium, the most common issue is determiningwhether the patient has dementia, delirium, or both.
- Obtain information from medical records, psychiatric records,medical staff, family, and other sources.
- Complete blood count (CBC).
- Blood tests (e.g., VDRL (Venereal Disease Research Laboratory test), heavy metal screen, B12 and folate levels, antinuclearantibody (ANA), urinary porphyrins, ammonia level, human immunodeficiency virus (HIV), erythrocyte sedimentation rate (ESR).
- Arterial blood gases or oxygen saturation.
- Urine culture and sensitivity (C&S).
- Urine drug screen.
- Blood cultures.
- Serum levels of medications.
- Cerebrospinal fluid (CSF) analysis.
- Chest X-ray.
- Brain computerized tomography (CT) or magnetic resonance imaging (MRI).
- Electroencephalogram (EEG).
- Optimizing conditions for the brain. This involves ensuring that the patient with delirium has adequate oxygenation, hydration, nutrition, and normal levels of metabolites, that drug effects are minimized, constipation treated, pain treated, and so on.
- Antipsychotic medication in low doses might sometimes be needed to control agitation, psychotic symptoms or aggression. Beware of drug side-effects and drug interactions. Antipsychotics, preferably those with minimal anticholinergic activity, such as haloperidol or risperidone may be preferred.
- When drugs are required because of severe behavioural disturbance or risk to self and/or others, low-dose risperidone is the usual drug of first choice, except in alcohol or drug withdrawal states or in patients with liver disease in might be helpful.
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