Acute Confusion

Question 1

Causes of Acute Confusion

Answer 1

Bacteraemia/Septicaemia
Delirium
Thyrotoxicosis 
Alcohol Withdrawal
Hypoxia
Post-Ictal Sate
Hypoglycaemia
hypothyroidism
Thiamine deficiency
Addisons Disease
Drugs
Frontal Lobe Lesion

Question 2

Systemic Causes of Acute Confusion

Answer 2

Hypoglycaemia
DKA
Endocrine Disease
Alcohol withdrawal
Sepsis
Vitamin Deficiency
Myocardial Ischaemia
Organ failure

Question 3

Investigations for Systemic Causes of Acute Confusion

Answer 3

U: Urine
B: Blood Cultures, WBC, RBC, MCV, Mg2+, amylase, porphyrins, thiamine, vitamin B12, folate, TFT, cardiac enzymes, ABG, U+Es, glucose, Calcium
E: ECG
I: CXR

Question 4

Investigations for suspected drug cause

Answer 4

Check prescribed medication, serum alcohol/drug screen

Question 5

Neurological Causes of Acute Infection

Answer 5

Post-ictal state
Dementia
Cerebrovascular accident (CVA) (especially non-dominant parietal lobe)
Intracranial bleed (SAH, subdural)
Infection (encephalitis, meningitis)
Trauma
Malignancy (primary or secondary)
Cerebral vasculitis (SLE, PAN)

Question 6

Investigations for neurological causes

Answer 6

As with Systemic

Consider CT scan with contrast, LP, EEG, blood cultures, CRP, syphilis serology, Lyme serology

Question 7

Investigations for malignant causes of Acute Confusion

Answer 7

Check CXR ± CT chest, serum Ca2+, CT brain

Question 8

Conservative Management

Answer 8

Re-orientate

Nurse in a moderately lit room, with repeated reassurance. See if a family member can stay with the patient.

Question 9

Only sedate if…

Answer 9

To facilitate essential tests and treatment for the patient’s beneficial
The patient is a danger to themselves or others Relieving distress in a highly agitated or hallucinating patient.

Question 10

What drugs are used for sedation?

Answer 10

Lorazepam
Haloperidol
Clomethiazole for alcohol withdrawal