Ramblings of a Ninja Insomniac

Delirium is most often caused by physical or mental illness and is usually temporary and reversible. Many disorders may cause delirium. Often, these disorders do not allow the brain to get oxygen or other substances. They may also cause dangerous chemicals (toxins) to build up in the brain. Delirium is common in the intensive care unit (ICU), especially in older adults.

Causes include:

Alcohol or medicine overdose or withdrawal

Drug use or overdose, including being sedated in the ICU

Electrolyte or other body chemical disturbances

Infections such as urinary tract infections, pneumonia, or meningitis

Certain medicines such as pain medicines, sedatives, or anticholinergic medicines

Severe lack of sleep

Poisons

General anesthesia and surgery

Autoimmune disease

Treatment

The goal of treatment is to control or reverse the cause of the symptoms.

Treatment depends on the condition causing delirium.

The person may need to stay in the hospital for a short time.

Stopping or changing medicines that may worsen confusion, or that are no longer needed, may improve mental function. 

Disorders that contribute to confusion should be treated. These may include:

Anemia

Decreased oxygen (hypoxia)

Heart failure

High carbon dioxide levels (hypercapnia)

Infections

Kidney failure

Liver failure

Metabolic disorders

Nutritional disorders

Psychiatric conditions (such as depression or psychosis)

Thyroid disorders 

Treating medical and mental disorders often greatly improves mental function.

Medicines may be needed to control aggressive or agitated behaviors.

These are usually started at very low dosages and adjusted as needed.

Some people with delirium may benefit from hearing aids, glasses, or cataract surgery.

Other treatments that may be helpful are:

Behavior modification to control unacceptable or dangerous behaviors.

Reality orientation to reduce disorientation.

Modifying the environment to help with orientation. This includes adjusting lights so one can keep track of day and night, clocks, and calendars. 

Prognosis

Acute conditions that cause delirium may occur with long-term (chronic) disorders that cause dementia. Acute brain syndromes may be reversible by treating the cause.

Delirium often lasts about 1 week.

It may take several weeks for mental function to return to normal.

Full recovery is usually expected, but depends on the underlying cause of the delirium.

POSSIBLE COMPLICATIONS. Problems that may result from delirium include:

Loss of ability to function or care for self

Loss of ability to interact

Progression to stupor or coma 

Side effects of medicines used to treat the disorder

PREVENTION. Treating the conditions that cause delirium can reduce its risk. In hospitalized people, avoiding or using a low dosage of sedatives, prompt treatment of metabolic disorders and infections, and using reality orientation programs will reduce the risk of delirium in those at high risk.

ALTERNATIVE NAMES. Acute confusional state. Acute brain syndrome.