10 facts about acute confusion
Discover 10 crucial facts about acute confusion, also known as delirium or acute confusional state, including its causes, symptoms, and effective treatment options. Learn how to identify and manage this condition in elderly patients to prevent long-term cognitive impairment and mortality.
In this article we will focus on acute confusion (also called delerium, or an acute confusional state, ACS). This is to distinguish it from chronic confusion (dementia and its causes).
1. Definition
Acute confusion is a mental state characterised by confusion, disorientation, and impaired thinking or memory. You will not able to think or remember clearly.
2. How common is it?
Very. It is particularly common amongst hospitalised elderly patients, with an estimated 15-50% of hospitalised elderly experiencing some form of delirium.
3. Who gets it? (risk factors)
Risk factors include advanced age, pre-existing cognitive impairment (such as dementia), multiple chronic illnesses, vision or hearing impairment, and history of previous attacks of delirium.
4. Causes (7 groups)
There are 7 common groups of causes (‘SIDMADS’):
- Surgery – post-op
- Infection – especially urinary tract infection (UTI), pneumonia or wound infection
- Dehydration – pre-renal AKI
- Medication (especially opiates and psychotropic drugs) – new, or dose change or dose wrong
- Alcohol (and other substance, i.e. recreational drugs) withdrawal (or excess)
- Diabetes (blood sugar high or low) and other metabolic imbalances (sodium, calcium; high or low)
- System (major body) failures – kidney (AKI), liver, heart, lung.
Note 1. Often it is multifactorial, e.g. elderly patient with pneumonia and dehydration (AKI) after an operation, given too much opiate etc (builds up in AKI).
Note 2. Alcohol withdrawal is also called delerium tremens or ‘DTs’
Note 3. Acute confusion which is a ‘brain disease’ is (strangely) not often caused by actual new brain disease, e.g stroke/TIA/meningitis. Encephalitis can present with acute confusion though.
5. Symptoms
Symptoms include altered level of consciousness, disorientation, impaired attention, hallucinations, restlessness, agitation, and sometimes withdrawal or lethargy.
Onset
Acute confusion develops rapidly, often within hours or days, and fluctuates throughout the day. Symptoms may be more severe at night.
6. Diagnosis
Diagnosis is primarily clinical and based on a detailed patient history, physical examination, and cognitive assessment. A ten-question mental test score is usually sufficient.
Investigations
- FBC, CRP, ABG
- Blood cultures
- U+E, LFT, bone, bicarbonate, glucose
- MSU, sputum or wound culture
- Chest x-ray (essential)
- CT head (if not getting better in 3 days) or some other indication.
7. Treatment
Management involves treating the underlying cause, ensuring a safe environment, reorientation techniques, maintaining hydration and nutrition; and sometimes using medications to control severe agitation or psychosis.
Reversible
With prompt and appropriate treatment, acute confusion is usually reversible, especially if the underlying cause is identified and treated rapidly and effectively.
8. Complications
But if it is not promptly treated, it can lead to longer hospital stays, prolonged cognitive impairment, and higher mortality rates, especially in the elderly.
9. Prevention
Preventive strategies include managing risk factors, ensuring proper hydration and nutrition, promoting sleep, minimising the use of high-risk medications, and encouraging early mobilisation in hospitalised patients.
10. Outlook
Acute confusion is usually transient and reversible (back to baseline cognitive level).
Summary
We have described 10 facts about acute confusion, focusing on its causes, symptoms and treatment options. We hope this information helps! 😊
