Delirium causes: Difference between revisions

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__NOTOC__
__NOTOC__
{{Delirium}}
{{Delirium}}
{{CMG}}; {{AE}} [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com];{{PB}}
{{CMG}}; {{AE}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com];{{Vbe}}


==Overview==
==Overview==
Delirium may be caused by severe physical or [[mental illness]], or any process which interferes with the normal metabolism or function of the brain.  For example, [[fever]], [[Pain and nociception|pain]], [[poison]]s (including toxic [[approved drug|drug]] reactions), brain injury, surgery, traumatic shock, severe lack of food or water or sleep, and even withdrawal symptoms of certain drug and [[alcohol]] dependent states, are all known to cause delirium.  In addition, there is an interaction between acute and chronic symptoms of brain dysfunction; delirious states are more easily produced in people already suffering with underlying chronic brain dysfunction.
[[Delirium]] may be caused by severe physical or [[mental illness]], or any process which interferes with the normal metabolism or function of the brain such as [[fever]], [[pain]], [[poison]] ([[toxic]] [[approved drug|drug]] reactions), [[brain]] injury, [[surgery]], [[traumatic]] shock, severe lack of [[food]] or [[water]] or [[sleep]], and even withdrawal symptoms of certain [[drug]] and [[alcohol]] dependent states.  In addition, there is an interaction between acute and chronic [[symptoms]] of [[brain]] dysfunction. [[Delirious]] states are more easily produced in people already suffering from underlying chronic [[brain]] dysfunction. A very common cause of [[delirium ]] in elderly people is a [[urinary tract infection]], which is easily treatable with [[antibiotics]].
[[Delirium]], like [[mental confusion]], is a very general and nonspecific symptom of [[organ]] dysfunction. In addition to many organic causes relating to a structural defect or a [[metabolic]] problem in the [[brain]], there are also some [[psychiatric]] causes, which may also include a component of [[mental]] or [[emotional]] stress, [[mental]] disease.
===Life Threatening Causes===
Life-threatening causes include [[conditions]] that may result in [[death]] or permanent disability within 24 hours if left untreated.<ref name="FarahLauand2015">{{cite journal|last1=Farah|first1=Julia de Lima|last2=Lauand|first2=Carolina Villar|last3=Chequi|first3=Lucas|last4=Fortunato|first4=Enrico|last5=Pasqualino|first5=Felipe|last6=Bignotto|first6=Luis Henrique|last7=Batista|first7=Rafael Loch|last8=Aprahamian|first8=Ivan|title=Severe Psychotic Disorder as the Main Manifestation of Adrenal Insufficiency|journal=Case Reports in Psychiatry|volume=2015|year=2015|pages=1–4|issn=2090-682X|doi=10.1155/2015/512430}}</ref><ref name="CleggYoung2010">{{cite journal|last1=Clegg|first1=A.|last2=Young|first2=J. B.|title=Which medications to avoid in people at risk of delirium: a systematic review|journal=Age and Ageing|volume=40|issue=1|year=2010|pages=23–29|issn=0002-0729|doi=10.1093/ageing/afq140}}</ref>


A very common cause of delirium in elderly people is a urinary tract infection, which is easily treatable with antibiotics, reversing the delirium.
 
Delirium, like mental confusion, is a very general and nonspecific symptom of organ dysfunction, where the organ in question is the brain. In addition to many organic causes relating to a structural defect or a metabolic problem in the brain (analogous to hardware problems in a computer), there are also some psychiatric causes, which may also include a component of mental or emotional stress, mental disease, or other "programming" problems (analogous to software problems in a computer).
* [[Acute liver failure]]
==Causes==
* Acute Metabolic ([[acidosis]], [[alkalosis]], [[renal failure]], [[Electrolyte disturbance|electrolyte imbalances]])
Too many to list by specific pathology, general categories of cause of delirium include:
* Acute [[vascular]] disorder  ([[Stroke]], [[MI]], [[pulmonary embolism]], [[heart failure]])
===Gross structural brain disorders===
* [[Adrenal cortex insufficiency]]
* [[Head trauma]] (i.e., [[concussion]], traumatic bleeding, penetrating injury, etc.)
* [[Altitude sickness|Acute Altitude sickness]]
* Gross structural damage from brain disease ([[stroke]], spontaneous bleeding, tumor, etc.)
* [[Brain infection]]
===Neurological disorders===
* [[Decompression sickness]]
* Various [[neurological disorders]]
* [[Gangrene]]
* Lack of [[sleep]]
* [[Head injury]]
===Circulatory===
* [[Diabetes|Hyperosmolar non-ketotic diabetic coma]]
* [[Idiopathic intracranial hypertension|Intracranial Hypertension]]
* [[Hyperthermia]]
===Lack of essential metabolic fuels, nutrients, etc.===
* [[Hypoglycemia]]
* [[Hypoxia (medical)|Hypoxia]],  
* [[Hypothermia]]
* [[Hypoglycemia]]  
* [[Electrolyte]] imbalance ([[dehydration]], water intoxication)
===Toxication===
* [[Intoxication]] various drugs, alcohol, anesthetics
* Sudden withdrawal of chronic drug use ("de-tox") in a person with certain types of [[drug addiction]] (e.g. alcohol, see [[delirium tremens]], and many other sedating drugs)
* [[Poisons]] (including carbon monoxide and metabolic blockade)
* [[Medication]]s including psychotropic medications
===Mental illness per se is not a cause, as a matter of definition===
Some mental illnesses, such as mania, or some types of acute psychosis, may cause a rapidly fluctuating impairment of cognitive function and ability to focus.  However, they are not technically causes of delirium, since any fluctuating cognitive symptoms that occur as a result of these mental disorders areconsidered''by definition'' to be due to the mental disorder itself, and to be a part of it.  Thus, ''physical'' disorders can be said to produce delirium as a mental side-effect or symptom; however primary ''mental'' disorders which produce the symptom cannot be put into this category, once identified.  However, such symptoms may be impossible to distinguish clinically from delirium resulting from physical disorders, if a diagnosis of an underlying mental disorder has yet to be made.
===Common causes of Delirium===
A mnemonic for the myriad causes of Delirium: '''IWATCHDEATH'''
* Infections (Pneumonia, Urinary Tract Infections)
* Withdrawal ([[Ethanol]],[[opiate]])
* Acute Metabolic ([[acidosis]], [[renal failure]], imbalances, [[alkalosis]])
* Trauma (acute severe pain)
* Central nervous system pathology ([[epilepsy]], [[cerebral haemorrhage]])
* [[Hypoxia]]
* [[Hypoxia]]
* Deficiencies ([[Vitamin_B12|vitamin B12]], [[thiamine]])
* [[Hypoxemia]]
* Endocriopathies (thyroid, parathyroid, [[hypopituitarism]], hyper/[[hypoglycemia]], Cushing's)
* [[Raised intracranial pressure]]
* Acute vascular ([[Stroke]], [[MI]], [[PE]], [[heart failure]])
* [[Rickettsiae]]
* Heavy metals
* [[Sepsis]]
* Toxins/drugs (prescribed - [[Tramadol]], recreational)
* [[Recreational drug use#Drugs popularly used for recreation|Toxins/drugs]]
===List of commonly prescribed medicines which may attribute to delirium===
* [[Recreational drug use#Drugs popularly used for recreation|Withdrawal]]
 
===List of Commonly Prescribed Medicines Attributing to [[Delirium]]===
* [[Antiarrhythmic]]
* [[Antiarrhythmic]]
* [[Antihistamine]]
* [[Antihistamine]]
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* [[Antispasmodic]]
* [[Antispasmodic]]
* [[Benzodiazepine]]
* [[Benzodiazepine]]
* [[Diuretic]] [[Furosemide]]
* [[Diuretic]] e.g. [[Furosemide]]
* Incontinence [[Oxybutynin]]
* Incontinence medicines e.g. [[Oxybutynin]]
* [[Opioid]] Analgesics
* [[Opioid]] Analgesics
* [[Tricyclic antidepressan]]t<ref>{{Cite web  | last = | first = | title = Delirium in older people | BMJ | url = http://www.bmj.com/content/334/7598/842 | publisher = | date = | accessdate = }}</ref>
* [[Tricyclic antidepressant]].<ref name="Alagiakrishnan2004">{{cite journal|last1=Alagiakrishnan|first1=K|title=An approach to drug induced delirium in the elderly|journal=Postgraduate Medical Journal|volume=80|issue=945|year=2004|pages=388–393|issn=0032-5473|doi=10.1136/pgmj.2003.017236}}</ref>
 
===Common Causes of [[Delirium]]===
 
* [[Infectious disease causes|Infections]] ([[Pneumonia]], [[Urinary Tract Infections]])
* [[Recreational]] [[drug]] use,Drugs popularly used for recreation|Withdrawal]] ([[ethanol]], [[opiate]])
* Acute Metabolic disroder ([[acidosis]], [[alkalosis]], [[renal failure]], [[Electrolyte disturbance|electrolyte imbalances]])
* [[Trauma]] ([[Pain|acute severe pain]])
* [[Central nervous system]] pathology ([[epilepsy]], [[cerebral hemorrhage]])
* [[Hypoxia]]
* [[Vitamin]] Deficiencies ([[Vitamin_B12|vitamin B12]], [[thiamine]])<ref name="MavrommatiSentissi2013">{{cite journal|last1=Mavrommati|first1=K|last2=Sentissi|first2=O|title=Delirium as a result of vitamin B12 deficiency in a vegetarian female patient|journal=European Journal of Clinical Nutrition|volume=67|issue=9|year=2013|pages=996–997|issn=0954-3007|doi=10.1038/ejcn.2013.128}}</ref>
* [[Endocrine diseases|Endocriopathies]]
* Acute [[vascular]] disease ([[Stroke]], [[MI]], [[pulmonary embolism]], [[heart failure]])
* [[Heavy metal ingestion|Heavy metals]]
* [[Recreational]] [[drug]] use<ref name="pmid19724721">{{cite journal |vauthors=Markowitz JD, Narasimhan M |title=Delirium and antipsychotics: a systematic review of epidemiology and somatic treatment options |journal=Psychiatry (Edgmont) |volume=5 |issue=10 |pages=29–36 |date=October 2008 |pmid=19724721 |pmc=2695757 |doi= |url=}}</ref>
 
===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Malignant hypertension]] , [[Heart failure]]  
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Malignant hypertension]], [[Heart failure]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Chemical/Poisoning'''
| '''Chemical/Poisoning'''
|bgcolor="Beige"|Withdrawal states  from ethanol, benzodiazepines , Water hemlock poisoning , [[Toxic mushrooms -- Monomethylhydrazine ]] , [[Toluene]] , Texas Mescalbean poisoning , Poison hemlock , [[Organic solvent]] , [[Methanol ]] , [[Marijuana]] , [[Lead]] , Jimson weed, , [[Hyperbaric sickness]] , [[Hydrogen sulfide  ]] , [[Heroin]] , [[Hallucinogens]] , [[Ethylene glycol]] , [[Ethanol]] , [[Daphne poisoning ]] , Cyanide , [[Carbon tetrachloride]] , [[Carbon monoxide toxicity]] , [[Alcohol withdrawal]] , Thallium Sulfate poisoning , Phencyclidine poisoning ,  Nickel Carbonyl poisoning  
|bgcolor="Beige"|Withdrawal states  from [[Ethanol]], [[Benzodiazepines]], [[Conium|Water hemlock poisoning]] , [[Toxic mushrooms|Monomethylhydrazine ]], [[Toluene]], [[Mescalbean|Texas Mescalbean poisoning]], [[Conium|Poison hemlock]], [[Organic solvent]], [[Methanol]], [[Marijuana]], [[Lead]], [[Datura stramonium|Jimson weed]], [[Hyperbaric sickness]], [[Hydrogen sulfide  ]], [[Heroin]], [[Hallucinogens]], [[Ethylene glycol]], [[Ethanol]], [[Daphne poisoning ]], [[Cyanide]], [[Carbon tetrachloride]], [[Carbon monoxide toxicity]], [[Alcohol withdrawal]], [[Thallium|Thallium Sulfate poisoning]], [[Phencyclidine|Phencyclidine poisoning]],  [[Nickel]], [[Carbonyl|Carbonyl poisoning]]


|-
|-
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"|[[Valproic acid]] , Skeletal muscle relaxers , [[Serotonin syndrome]] , Quinolones , [[Lithium]] , [[Drug withdrawal]] , [[Drug overdose]] , [[Cabergoline]] , [[Antipsychotics]], [[Antihistamines]]  
|bgcolor="Beige"|[[Antihistamines]], [[Antipsychotics]], [[Atropine]], [[Cabergoline]], [[Chloramphenicol sodium succinate]], [[Clobazam]], [[Cidofovir]], [[Drug overdose]], [[Drug withdrawal]], [[Lithium]], [[Meropenem]], [[Muscle relaxants]], [[Oxcarbazepine]], [[Promethazine]], [[Quinolones]], [[Serotonin syndrome]], [[Valproic acid]], [[Zanamivir]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|[[Pituitary apoplexy]] , [[Phaeochromocytoma]] , [[Hypothyroidism]] , [[Hypopituitarism]] , [[Hypoglycemia]] , [[Hyperthyroidism]] , [[Hyperosmolar non-ketotic diabetic coma]] , [[Hyperglycemia]] , [[Hyperthyroidism]] , Elevated or depressed pituitary function , Elevated or depressed adrenal function , [[Diabetic ketoacidosis]] , [[Diabetic hypoglycemia]] , [[Cushing syndrome]] , [[Adrenal cortex insufficiency]]  
|bgcolor="Beige"|[[Pituitary apoplexy]], [[Phaeochromocytoma]], [[Hypothyroidism]], [[Hypopituitarism]], [[Hypoglycemia]], [[Hyperthyroidism]], [[Diabetes|Hyperosmolar non-ketotic diabetic coma]], [[Hyperglycemia]], [[Hyperthyroidism]], [[Endocrine diseases|Elevated or depressed pituitary function]] ,[[Cushing's syndrome|Elevated]] or [[Adrenal insufficiency|Depressed adrenal function]], [[Diabetic ketoacidosis]], [[Diabetic hypoglycemia]], [[Cushing syndrome]], [[Adrenal cortex insufficiency]]  
|-  
|-  
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"|[[Hypothermia]] , [[Hyperthermia]] , [[Heat stroke]] , [[Electric shock]] , [[Decompression sickness]] , Acute Altitude sickness  
|bgcolor="Beige"|[[Hypothermia]], [[Hyperthermia]], [[Heat stroke]], [[Electric shock]], [[Decompression sickness]], [[Altitude sickness|Acute Altitude sickness]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"|Elevated or depressed pancreas function , Chronic [[Liver failure]] , Acute [[Liver failure]]
|bgcolor="Beige"|[[pancreas|Elevated or depressed pancreas function]], [[Liver failure|Chronic Liver failure]], [[Acute liver failure]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"|[[Thrombocytosis]] , [[Polycythemia]] , Leukemic blast cell crisis , [[Hypereosinophilia]]  
|bgcolor="Beige"|[[Thrombocytosis]], [[Polycythemia]], [[Acute lymphoblastic leukemia natural history, complications and prognosis|Leukemic blast cell crisis]], [[Hypereosinophilia]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"|Postoperative [[stress]]
|bgcolor="Beige"|[[stress|Postoperative stress]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"|Viral Hemorrhagic Fevers  , [[Vancomycin resistant enterococcal bacteremia]] , [[Urinary tract infection]] , [[Typhoid fever]] , [[systemic inflammatory response syndrome]] , Systemic infections , Surgical wound infection , [[Subdural empyema]] , [[Sleeping sickness (West African)]] , [[Sleeping sickness (East African)]] , [[Sepsis]] , [[Rickettsiae]] , [[Rabies ]] , [[Pyelonephritis, acute]] , [[Plague ]] , [[Neurocysticercosis]] , [[Malaria]] , Intraspinal abscess / granuloma , Intracranial abscess / granuloma , [[Infections  ]] , [[Gangrene ]] , Chest infection , [[Cerebral malaria]] , Brain or epidural abscess , [[Brain infection]]  
|bgcolor="Beige"|[[Viral hemorrhagic fever]], [[Vancomycin resistant enterococcal bacteremia]], [[Urinary tract infection]], [[Typhoid fever]], [[Systemic inflammatory response syndrome]], [[Systemic infection]], [[Wound#Infection|Surgical wound infection]], [[Subdural empyema]], [[Sleeping sickness (West African)]], [[Sleeping sickness (East African)]], [[Sepsis]], [[Rickettsiae]], [[Rabies ]], [[Pyelonephritis]], [[Plague]], [[Neurocysticercosis]], [[Malaria]], [[Central nervous system infection|Intraspinal abscess / granuloma, Intracranial abscess / granuloma]], [[Gangrene]], [[Lower respiratory tract infection classification|Chest infection]], [[Cerebral malaria]], [[Central nervous system infection|Brain or epidural abscess]], [[Brain infection]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"|[[Venous sinus thrombosis]] , [[Raised intracranial pressure]] , Post-ictal states , [[Nonconvulsive status epilepticus]] , [[Meningoencephalitis]] , [[Meningitis]] , [[Intracranial bleeding]] , [[Hypertensive encephalopathy]] , [[Epileptic seizures]] , [[Epidural haemorrhage]] , [[Encephalitis]] , [[Encephalitis]] , [[Cerebrovascular accident]] , [[Cerebral oedema]] , [[Cerebral infarction]] , [[Brain tumor]] , Brain bleeding , [[Brain abscess]]
|bgcolor="Beige"|[[Venous sinus thrombosis]], [[Raised intracranial pressure]], [[Postictal state]], [[Nonconvulsive status epilepticus]], [[Meningoencephalitis]], [[Meningitis]], [[Intracranial bleeding]], [[Hypertensive encephalopathy]], [[Epileptic seizures]], [[Epidural haemorrhage]], [[Encephalitis]], [[Encephalitis]], [[Cerebrovascular accident]], [[Cerebral oedema]], [[Cerebral infarction]], [[Brain tumor]], [[Brain abscess]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"|[[Wilson's disease]] , [[Wernicke's encephalopathy]] , [[Vitamin B12 deficiency]] , [[Thiamine (Vitamin B1) deficiency]] , Niacin deficiencies ,  
|bgcolor="Beige"|[[Wilson's disease]], [[Wernicke's encephalopathy]], [[Vitamin B12 deficiency]], [[Thiamine (Vitamin B1) deficiency]], [[Niacin|Niacin  deficiencies]], [[Folate  deficiency]], [[Acute intermittent porphyria]]  
[[Folate  deficiency]] , [[Acute intermittent porphyria]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"|[[Schizoaffective disorder ]] , Mental stress , Mental exhaustion
|bgcolor="Beige"|[[Schizoaffective disorder ]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"|[[Respiratory failure]] , [[Hypoxemia]] , [[Hypercarbia]]
|bgcolor="Beige"|[[Respiratory failure]], [[Hypoxemia]], [[Hypercarbia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"|[[Hypophosphatemia]] , hypoosmolar states , [[Hyponatremia]] , [[Hypocalcemia]] , Hyperosmolar states , [[Hypernatremia]] ,  
|bgcolor="Beige"|[[Hypophosphatemia]], [[Hyponatremia causes|Hypoosmolar states]], [[Hyponatremia]], [[Hypocalcemia]], [[Hyperosmolar syndrome|Hyperosmolar states]], [[Hypernatremia]],  
[[Hypermagnesemia]] , [[Hypercalcemia]] , [[Hypomagnesemia]] , [[Hyperphosphatemia]] , Chronic [[Renal failure]] , Acute [[Renal failure]]  
[[Hypermagnesemia]], [[Hypercalcemia]], [[Hypomagnesemia]], [[Hyperphosphatemia]], [[Chronic renal failure]], [[Acute renal failure]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"|[[Trauma]] , [[Skull fracture]] , [[Head injury]]   
|bgcolor="Beige"|[[Trauma]], [[Skull fracture]], [[Head injury]]   
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Urinary Track Infection]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"|Coproporphyria , [[Burns]]
|bgcolor="Beige"|[[porphyria|Coproporphyria]], [[Burns]]
|-
|-
|}
|}
===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{Multicol}}
{{columns-list|
*[[Altitude sickness|Acute altitude sickness]]
*[[Acute intermittent porphyria]]
*[[Acute intermittent porphyria]]
*Acute Liver failure
*[[Acute liver failure]]
*Acute Renal failure
*[[Acute renal failure]]
*[[Adrenal cortex insufficiency]]
*[[Adrenal cortex insufficiency]]
*[[Alcohol withdrawal]]
*[[Alcohol withdrawal]]
*Altitude sickness, acute
*[[Antihistamines]]
*[[Antihistamines]]
*[[Antipsychotics]]
*[[Antipsychotics]]
*[[Brain abscess]]
*[[Brain abscess]]
*Brain bleeding
*[[Brain infection]]
*[[Brain infection]]
*Brain or epidural abscess
*[[Central nervous system infection|Brain or epidural abscess]]
*[[Brain tumor]]
*[[Brain tumor]]
*[[Burns]]
*[[Burns]]
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*[[Cerebral oedema]]
*[[Cerebral oedema]]
*[[Cerebrovascular accident]]
*[[Cerebrovascular accident]]
*Chest infection
*[[Lower respiratory tract infection classification|Chest infection]]
*Chronic Liver failure
*[[Liver failure|Chronic Liver failure]]
*Chronic Renal failure
*[[Chronic renal failure]]
*[[Coproporphyria, hereditary]]
*[[Coproporphyria, hereditary]]
*[[Cushing syndrome]]
*[[Cushing syndrome]]
*Cyanide
*[[Cyanide]]
*[[Daphne poisoning ]]
*[[Daphne poisoning ]]
*[[Decompression sickness]]
*[[Decompression sickness]]
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*[[Drug withdrawal]]
*[[Drug withdrawal]]
*[[Electric shock]]
*[[Electric shock]]
*Elevated or depressed adrenal function
*[[Endocrine diseases|Elevated or depressed adrenal function]]
*Elevated or depressed pancreas function
*[[Endocrine diseases|Elevated or depressed pancreas function]]
*Elevated or depressed pituitary function
*[[Endocrine diseases|Elevated or depressed pituitary function]]
*[[Encephalitis]]
*[[Encephalitis]]
*[[Encephalitis]]
*[[Encephalitis]]
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*[[Head injury]]
*[[Head injury]]
*[[Heart failure]]
*[[Heart failure]]
{{ColBreak}}
*[[Heat stroke]]
*[[Heat stroke]]
*[[Heroin]]
*[[Heroin]]
*[[Hperthyroidism]]
*[[Thyroid#Diseases|Hperthyroidism]]
*[[Hpherphosphatemia]]
*[[Electrolyte disturbance|Hpherphosphatemia]]
*[[Hydrogen sulfide ]]
*[[Hydrogen sulfide]]
*[[Hyomagnesemia]]
*[[Electrolyte disturbance|Hyomagnesemia]]
*[[Hyperbaric sickness]]
*[[Hyperbaric sickness]]
*[[Hypercalcemia]]
*[[Hypercalcemia]]
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*[[Hypereosinophilia]]
*[[Hypereosinophilia]]
*[[Hyperglycemia]]
*[[Hyperglycemia]]
*[[Hypermagnesemia]]
*[[Electrolyte disturbance|Hypermagnesia]]
*[[Hypernatremia]]
*[[Hypernatremia]]
*[[Hyperosmolar non-ketotic diabetic coma]]
*[[Hyperosmolar non-ketotic diabetic coma]]
*Hyperosmolar states
*[[Hyperosmolar syndrome|Hyperosmolar states]]
*[[Hypertensive encephalopathy]]
*[[Hypertensive encephalopathy]]
*[[Hyperthermia]]
*[[Hyperthermia]]
*[[Hyperthyroidism]]
*[[Hyperthyroid]]
*[[Hypocalcemia]]
*[[Hypocalcemia]]
*[[Hypoglycemia]]
*[[Hypoglycemia]]
*[[Hyponatremia]]
*[[Hyponatremia]]
*hypoosmolar states
*[[Hyponatremia causes|hypoosmolar states]]
*[[Hypophosphatemia]]
*[[Hypophosphatemia]]
*[[Hypopituitarism]]
*[[Hypopituitarism]]
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*[[Intracranial abscess / granuloma]]
*[[Intracranial abscess / granuloma]]
*[[Intracranial bleeding]]
*[[Intracranial bleeding]]
*Intraspinal abscess / granuloma
*[[Central nervous system infection|Intraspinal abscess / granuloma]]
*Jimson weed
*[[Datura stramonium|Jimson weed]]
*[[Lead]]
*[[Lead]]
*Leukemic blast cell crisis
*[[Acute lymphoblastic leukemia natural history, complications and prognosis|Leukemic blast cell crisis]]
*[[Lithium]]
*[[Lithium]]
*[[Liver failure]]
*[[Liver failure]]
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*[[Meningitis]]
*[[Meningitis]]
*[[Meningoencephalitis]]
*[[Meningoencephalitis]]
*Mental exhaustion
*Mental stress
*[[Methanol]]
*[[Methanol]]
*[[Toxic mushrooms|Monomethylhydrazine]]
*[[Muscle relaxant]]
*[[Neurocysticercosis]]
*[[Neurocysticercosis]]
*Niacin deficiencies
*[[Niacin|Niacin deficiencies]]
*Nickel Carbonyl poisoning
*[[Nickel|Nickel poisoning]]
*[[Nonconvulsive status epilepticus]]
*[[Nonconvulsive status epilepticus]]
{{ColBreak}}
*[[Organic solvent]]
*[[Organic solvent]]
*[[Phaeochromocytoma]]
*[[Phaeochromocytoma]]
*Phencyclidine poisoning
*[[Phencyclidine]]
*[[Pituitary apoplexy]]
*[[Pituitary apoplexy]]
*[[Plague ]]
*[[Plague]]
*Poison hemlock
*[[Conium|Poison hemlock]]
*[[Polycythemia]]
*[[Polycythemia]]
*[[Porphyria]]
*[[Porphyria]]
*Post-ictal states
*[[Postictal state]]
*Postoperative stress
*[[stress|Postoperative stress]]
*[[Pyelonephritis, acute]]
*[[Pyelonephritis]]
*Quinolones
*[[Quinolones]]
*[[Rabies ]]
*[[Rabies]]
*[[Raised intracranial pressure]]
*[[Raised intracranial pressure]]
*[[Renal failure, acute]]
*[[Renal failure, acute]]
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*[[Sepsis]]
*[[Sepsis]]
*[[Serotonin syndrome]]
*[[Serotonin syndrome]]
*Skeletal muscle relaxers
*[[Skull fracture]]
*[[Skull fracture]]
*[[Sleeping sickness (East African)]]
*[[Sleeping sickness (East African)]]
*[[Sleeping sickness (West African)]]
*[[Sleeping sickness (West African)]]
*[[Subdural empyema]]
*[[Subdural empyema]]
*Surgical wound infection
*[[Wound#Infection|Surgical wound infection]]
*Systemic infections
*[[Systemic infection]]
*[[systemic inflammatory response syndrome]]
*[[systemic inflammatory response syndrome]]
*Systemic organ failure   
*[[Multiple organ dysfunction syndrome|Systemic organ failure]]  
*Texas Mescalbean poisoning  
*[[Mescalbean|Texas Mescalbean poisoning]]
*[[Thallium|Thallium Sulfate poisoning]]
*[[Thiamine (Vitamin B1) deficiency]]
*[[Thiamine (Vitamin B1) deficiency]]
*Thallium Sulfate poisoning
*[[Thrombocytosis]]
*[[Thrombocytosis]]
*[[Toluene]]
*[[Toluene]]
*[[Toxic mushrooms -- Monomethylhydrazine]]
*[[Trauma]]
*[[Trauma]]
*[[Typhoid fever]]
*[[Typhoid fever]]
Line 315: Line 314:
*[[Vasculitis]]
*[[Vasculitis]]
*[[Venous sinus thrombosis]]
*[[Venous sinus thrombosis]]
*Viral Hemorrhagic Fevers
*[[Viral hemorrhagic fever]]
*[[Vitamin B12 deficiency]]
*[[Vitamin B12 deficiency]]
*Water hemlock poisoning
*[[Conium|Water hemlock poisoning]]
*[[Wernicke's encephalopathy]]
*[[Wernicke's encephalopathy]]
*[[Wilson's disease]]
*[[Wilson's disease]]
*Withdrawal states from [[ethanol]], [[benzodiazepines]]
*Withdrawal states e.g. [[ethanol]], [[benzodiazepines]]
{{EndMultiCol}}
*[[Zanamivir]]
=== Risk Factors ===
}}
*Older age
*Cognitive impairment / [[dementia]]
*Physical comorbidity (biventricular failure, cancer, [[cerebrovascular disease]])
*Psychiatric comorbidity (e.g. depression)
*Sensory impairment (vision, hearing)
*Functional dependence (e.g. requiring assistance for self-care and/or mobility)
*[[Dehydration]] / [[Malnutrition]]
*Drugs and drug-dependence.
*Alcohol dependence
===Precipitating factors===
Any acute factors that affect neurotransmitter, [[neuroendocrine]] or neuroinflammatory pathways can precipitate an episode of delirium in a vulnerable brain. Clinical environments can also precipitate delirium, and optimal nursing and medical care is a key component of delirium prevention.<ref>{{cite journal|last=Inouye|first=SK|coauthors=Bogardus ST, Jr; Charpentier, PA; Leo-Summers, L; Acampora, D; Holford, TR; Cooney LM, Jr|title=A multicomponent intervention to prevent delirium in hospitalized older patients.|journal=The New England Journal of Medicine|date=Mar 4, 1999|volume=340|issue=9|pages=669–76|pmid=10053175|doi=10.1056/NEJM199903043400901}}</ref>  Some of the most common precipitating factors are listed below:
*Metabolic
*[[Malnutrition]]
*[[Dehydration]], [[electrolyte imbalance]]
*[[Anaemia]]
*[[Hypoxia]]
*[[Hypercapnoea]]
*[[Hypoglycaemia]]
*[[Endocrine disorders]] (e.g. [[SIADH]], [[Addison’s disease]], [[hyperthyroidism]], [[hypercalcaemia]])
*[[Infection]]
*Especially respiratory and urinary tract infections
*Medication
*[[Anticholinergics]], [[dopaminergics]], [[opioids]], [[steroids]], recent polypharmacy
*Vascular
*[[Stroke]]/[[Transient ischaemic attack]]
*[[Myocardial infarction]], [[arrhythmias]], decompensated [[heart failure]]
*Physical/psychological stress
*Pain
*Iatrogenic event, esp. post-operative, mechanical ventilation in ICU
*Chronic/terminal illness, esp. cancer
*Post-traumatic event, e.g. fall, fracture
*Immobilisation/restraint
*Other
*Substance withdrawal, esp. alcohol, benzodiazepines
*Substance intoxication
**Traumatic head injury
===Due to unspecified etiology===
* Unrecognized medication use or substance abuse is the cause of an intoxication or withdrawal delirium,
* A rare cause may surface later, such as disseminated intravascular coagulation,
* Environmental factors.


==References==
==References==

Latest revision as of 07:13, 22 April 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]; Vishal Khurana, M.B.B.S., M.D. [3];Vindhya BellamKonda, M.B.B.S [4]

Overview

Delirium may be caused by severe physical or mental illness, or any process which interferes with the normal metabolism or function of the brain such as fever, pain, poison (toxic drug reactions), brain injury, surgery, traumatic shock, severe lack of food or water or sleep, and even withdrawal symptoms of certain drug and alcohol dependent states. In addition, there is an interaction between acute and chronic symptoms of brain dysfunction. Delirious states are more easily produced in people already suffering from underlying chronic brain dysfunction. A very common cause of delirium in elderly people is a urinary tract infection, which is easily treatable with antibiotics. Delirium, like mental confusion, is a very general and nonspecific symptom of organ dysfunction. In addition to many organic causes relating to a structural defect or a metabolic problem in the brain, there are also some psychiatric causes, which may also include a component of mental or emotional stress, mental disease.

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.[1][2]


List of Commonly Prescribed Medicines Attributing to Delirium

Common Causes of Delirium

Causes by Organ System

Cardiovascular Malignant hypertension, Heart failure
Chemical/Poisoning Withdrawal states from Ethanol, Benzodiazepines, Water hemlock poisoning , Monomethylhydrazine , Toluene, Texas Mescalbean poisoning, Poison hemlock, Organic solvent, Methanol, Marijuana, Lead, Jimson weed, Hyperbaric sickness, Hydrogen sulfide , Heroin, Hallucinogens, Ethylene glycol, Ethanol, Daphne poisoning , Cyanide, Carbon tetrachloride, Carbon monoxide toxicity, Alcohol withdrawal, Thallium Sulfate poisoning, Phencyclidine poisoning, Nickel, Carbonyl poisoning
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Antihistamines, Antipsychotics, Atropine, Cabergoline, Chloramphenicol sodium succinate, Clobazam, Cidofovir, Drug overdose, Drug withdrawal, Lithium, Meropenem, Muscle relaxants, Oxcarbazepine, Promethazine, Quinolones, Serotonin syndrome, Valproic acid, Zanamivir
Ear Nose Throat No underlying causes
Endocrine Pituitary apoplexy, Phaeochromocytoma, Hypothyroidism, Hypopituitarism, Hypoglycemia, Hyperthyroidism, Hyperosmolar non-ketotic diabetic coma, Hyperglycemia, Hyperthyroidism, Elevated or depressed pituitary function ,Elevated or Depressed adrenal function, Diabetic ketoacidosis, Diabetic hypoglycemia, Cushing syndrome, Adrenal cortex insufficiency
Environmental Hypothermia, Hyperthermia, Heat stroke, Electric shock, Decompression sickness, Acute Altitude sickness
Gastroenterologic Elevated or depressed pancreas function, Chronic Liver failure, Acute liver failure
Genetic No underlying causes
Hematologic Thrombocytosis, Polycythemia, Leukemic blast cell crisis, Hypereosinophilia
Iatrogenic Postoperative stress
Infectious Disease Viral hemorrhagic fever, Vancomycin resistant enterococcal bacteremia, Urinary tract infection, Typhoid fever, Systemic inflammatory response syndrome, Systemic infection, Surgical wound infection, Subdural empyema, Sleeping sickness (West African), Sleeping sickness (East African), Sepsis, Rickettsiae, Rabies , Pyelonephritis, Plague, Neurocysticercosis, Malaria, Intraspinal abscess / granuloma, Intracranial abscess / granuloma, Gangrene, Chest infection, Cerebral malaria, Brain or epidural abscess, Brain infection
Musculoskeletal/Orthopedic No underlying causes
Neurologic Venous sinus thrombosis, Raised intracranial pressure, Postictal state, Nonconvulsive status epilepticus, Meningoencephalitis, Meningitis, Intracranial bleeding, Hypertensive encephalopathy, Epileptic seizures, Epidural haemorrhage, Encephalitis, Encephalitis, Cerebrovascular accident, Cerebral oedema, Cerebral infarction, Brain tumor, Brain abscess
Nutritional/Metabolic Wilson's disease, Wernicke's encephalopathy, Vitamin B12 deficiency, Thiamine (Vitamin B1) deficiency, Niacin deficiencies, Folate deficiency, Acute intermittent porphyria
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Schizoaffective disorder
Pulmonary Respiratory failure, Hypoxemia, Hypercarbia
Renal/Electrolyte Hypophosphatemia, Hypoosmolar states, Hyponatremia, Hypocalcemia, Hyperosmolar states, Hypernatremia,

Hypermagnesemia, Hypercalcemia, Hypomagnesemia, Hyperphosphatemia, Chronic renal failure, Acute renal failure

Rheumatology/Immunology/Allergy Vasculitis
Sexual No underlying causes
Trauma Trauma, Skull fracture, Head injury
Urologic Urinary Track Infection
Miscellaneous Coproporphyria, Burns

Causes in Alphabetical Order

References

  1. ↑ Farah, Julia de Lima; Lauand, Carolina Villar; Chequi, Lucas; Fortunato, Enrico; Pasqualino, Felipe; Bignotto, Luis Henrique; Batista, Rafael Loch; Aprahamian, Ivan (2015). "Severe Psychotic Disorder as the Main Manifestation of Adrenal Insufficiency". Case Reports in Psychiatry. 2015: 1–4. doi:10.1155/2015/512430. ISSN 2090-682X.
  2. ↑ Clegg, A.; Young, J. B. (2010). "Which medications to avoid in people at risk of delirium: a systematic review". Age and Ageing. 40 (1): 23–29. doi:10.1093/ageing/afq140. ISSN 0002-0729.
  3. ↑ Alagiakrishnan, K (2004). "An approach to drug induced delirium in the elderly". Postgraduate Medical Journal. 80 (945): 388–393. doi:10.1136/pgmj.2003.017236. ISSN 0032-5473.
  4. ↑ Mavrommati, K; Sentissi, O (2013). "Delirium as a result of vitamin B12 deficiency in a vegetarian female patient". European Journal of Clinical Nutrition. 67 (9): 996–997. doi:10.1038/ejcn.2013.128. ISSN 0954-3007.
  5. ↑ Markowitz JD, Narasimhan M (October 2008). "Delirium and antipsychotics: a systematic review of epidemiology and somatic treatment options". Psychiatry (Edgmont). 5 (10): 29–36. PMC 2695757. PMID 19724721.

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