Delirium other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Khurana, M.B.B.S., M.D. [2]

Overview

Investigations

To identify underlying etiology following investigations are recommended:

• Complete blood count

• Serum Calcium

• Kidney function tests

• electrolytes

• Liver function tests
• Blood sugar level
• Thyroid function tests
• Chest X‑ray
• ECG
• Blood cultures

• Urinalysis

If indicated:

• • EEG

• • CT head

• • B12 and folate levels

• • Arterial blood gases

• • Specific cultures eg urine, sputum

• • Lumbar puncture

EEG

Although the EEG is frequently abnormal in those with delirium [27‑29], showing diffuse slowing, its routine use as a diagnostic tool has not been fully evaluated. EEG may be useful where there is difficulty in the following situations (grade III):

· Differentiating delirium from dementia

· Differentiating delirium from non‑convulsive status epilepticus and temporal lobe epilepsy

· Identifying those patients in whom the delirium is due to a focal intracranial lesion, rather than a global abnormality.

Lumbar puncture

Although various abnormalities have been seen in the CSF of patients with delirium [30], routine LP is not helpful [31] in identifying an underlying cause for the delirium (grade III). It should therefore be reserved for those in whom there is reason to suspect a cause such as meningitis. This might include patients with the following features:

· Meningism

· Headache and fever