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];Associate Editor(s)-in-Chief: 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 e.g.fever, pain, poison (including 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, 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.
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).
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes of Delirium
A mnemonic for the myriad causes of Delirium: IWATCHDEATH
- Infections (Pneumonia, Urinary Tract Infections)
- Withdrawal (ethanol, opiate)
- Acute Metabolic (acidosis, alkalosis, renal failure, electrolyte imbalances)
- Trauma (acute severe pain)
- Central nervous system pathology (epilepsy, cerebral hemorrhage)
- Hypoxia
- Vitamin Deficiencies (vitamin B12, thiamine)
- Endocriopathies
- Acute vascular (Stroke, MI, PE, heart failure)
- Heavy metals
- Toxins/drugs.
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
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References
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