Delirium causes: Difference between revisions

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==Overview==
==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 and nociception|pain]], [[poison]] (including toxic [[approved drug|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.
[[Delirium]] may be caused by severe physical or [[mental illness]], or any process which interferes with the normal metabolism or function of the brain such as [[fever]], [[pain]], [[poison]] ([[toxic]] [[approved drug|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.  In addition, there is an interaction between acute and chronic [[symptoms]] of [[brain]] dysfunction. [[Delirious]] states are more easily produced in people already suffering from underlying chronic [[brain]] dysfunction. A very common cause of [[delirium ]] in elderly people is a [[urinary tract infection]], which is easily treatable with [[antibiotics]].
[[Delirium]], like [[mental confusion]], is a very general and nonspecific symptom of [[organ]] dysfunction. In addition to many organic causes relating to a structural defect or a [[metabolic]] problem in the [[brain]], there are also some [[psychiatric]] causes, which may also include a component of [[mental]] or [[emotional]] stress, [[mental]] disease.
===Life Threatening Causes===
Life-threatening causes include [[conditions]] that may result in [[death]] or permanent disability within 24 hours if left untreated.<ref name="FarahLauand2015">{{cite journal|last1=Farah|first1=Julia de Lima|last2=Lauand|first2=Carolina Villar|last3=Chequi|first3=Lucas|last4=Fortunato|first4=Enrico|last5=Pasqualino|first5=Felipe|last6=Bignotto|first6=Luis Henrique|last7=Batista|first7=Rafael Loch|last8=Aprahamian|first8=Ivan|title=Severe Psychotic Disorder as the Main Manifestation of Adrenal Insufficiency|journal=Case Reports in Psychiatry|volume=2015|year=2015|pages=1–4|issn=2090-682X|doi=10.1155/2015/512430}}</ref><ref name="CleggYoung2010">{{cite journal|last1=Clegg|first1=A.|last2=Young|first2=J. B.|title=Which medications to avoid in people at risk of delirium: a systematic review|journal=Age and Ageing|volume=40|issue=1|year=2010|pages=23–29|issn=0002-0729|doi=10.1093/ageing/afq140}}</ref>
 


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.
* [[Acute liver failure]]
* [[Acute liver failure]]
* Acute Metabolic ([[acidosis]], [[alkalosis]], [[renal failure]], [[Electrolyte disturbance|electrolyte imbalances]])
* Acute Metabolic ([[acidosis]], [[alkalosis]], [[renal failure]], [[Electrolyte disturbance|electrolyte imbalances]])
* Acute vascular ([[Stroke]], [[MI]], [[PE]], [[heart failure]])
* Acute [[vascular]] disorder  ([[Stroke]], [[MI]], [[pulmonary embolism]], [[heart failure]])
* [[Adrenal cortex insufficiency]]
* [[Adrenal cortex insufficiency]]
* [[Altitude sickness|Acute Altitude sickness]]
* [[Altitude sickness|Acute Altitude sickness]]
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* [[Recreational drug use#Drugs popularly used for recreation|Toxins/drugs]]
* [[Recreational drug use#Drugs popularly used for recreation|Toxins/drugs]]
* [[Recreational drug use#Drugs popularly used for recreation|Withdrawal]]
* [[Recreational drug use#Drugs popularly used for recreation|Withdrawal]]
===Common Causes of Delirium===
 
A mnemonic for the myriad causes of Delirium: '''IWATCHDEATH'''
===List of Commonly Prescribed Medicines Attributing to [[Delirium]]===
* [[Antiarrhythmic]]
* [[Antihistamine]]
* [[Antiparkinsonian]]  drugs such as [[benzatropine]]
* [[Antispasmodic]]
* [[Benzodiazepine]]
* [[Diuretic]] e.g. [[Furosemide]]
* Incontinence medicines e.g. [[Oxybutynin]]
* [[Opioid]] Analgesics
* [[Tricyclic antidepressant]].<ref name="Alagiakrishnan2004">{{cite journal|last1=Alagiakrishnan|first1=K|title=An approach to drug induced delirium in the elderly|journal=Postgraduate Medical Journal|volume=80|issue=945|year=2004|pages=388–393|issn=0032-5473|doi=10.1136/pgmj.2003.017236}}</ref>
 
===Common Causes of [[Delirium]]===
 
* [[Infectious disease causes|Infections]] ([[Pneumonia]], [[Urinary Tract Infections]])
* [[Infectious disease causes|Infections]] ([[Pneumonia]], [[Urinary Tract Infections]])
* [[Recreational drug use#Drugs popularly used for recreation|Withdrawal]] ([[ethanol]], [[opiate]])
* [[Recreational]] [[drug]] use,Drugs popularly used for recreation|Withdrawal]] ([[ethanol]], [[opiate]])
* Acute Metabolic ([[acidosis]], [[alkalosis]], [[renal failure]], [[Electrolyte disturbance|electrolyte imbalances]])
* Acute Metabolic disroder ([[acidosis]], [[alkalosis]], [[renal failure]], [[Electrolyte disturbance|electrolyte imbalances]])
* [[Trauma]] ([[Pain|acute severe pain]])
* [[Trauma]] ([[Pain|acute severe pain]])
* Central nervous system pathology ([[epilepsy]], [[cerebral hemorrhage]])
* [[Central nervous system]] pathology ([[epilepsy]], [[cerebral hemorrhage]])
* [[Hypoxia]]
* [[Hypoxia]]
* Vitamin Deficiencies ([[Vitamin_B12|vitamin B12]], [[thiamine]])
* [[Vitamin]] Deficiencies ([[Vitamin_B12|vitamin B12]], [[thiamine]])<ref name="MavrommatiSentissi2013">{{cite journal|last1=Mavrommati|first1=K|last2=Sentissi|first2=O|title=Delirium as a result of vitamin B12 deficiency in a vegetarian female patient|journal=European Journal of Clinical Nutrition|volume=67|issue=9|year=2013|pages=996–997|issn=0954-3007|doi=10.1038/ejcn.2013.128}}</ref>
* [[Endocrine diseases|Endocriopathies]]  
* [[Endocrine diseases|Endocriopathies]]  
* Acute vascular ([[Stroke]], [[MI]], [[PE]], [[heart failure]])
* Acute [[vascular]] disease ([[Stroke]], [[MI]], [[pulmonary embolism]], [[heart failure]])
* [[Heavy metal ingestion|Heavy metals]]
* [[Heavy metal ingestion|Heavy metals]]
* [[Recreational drug use#Drugs popularly used for recreation|Toxins/drugs]].
* [[Recreational]] [[drug]] use<ref name="pmid19724721">{{cite journal |vauthors=Markowitz JD, Narasimhan M |title=Delirium and antipsychotics: a systematic review of epidemiology and somatic treatment options |journal=Psychiatry (Edgmont) |volume=5 |issue=10 |pages=29–36 |date=October 2008 |pmid=19724721 |pmc=2695757 |doi= |url=}}</ref>
 
===Causes by Organ System===
===Causes by Organ System===
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===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{columns-list|3|
{{columns-list|
*[[Altitude sickness|Acute altitude sickness]]
*[[Altitude sickness|Acute altitude sickness]]
*[[Acute intermittent porphyria]]
*[[Acute intermittent porphyria]]

Latest revision as of 07:13, 22 April 2021

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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];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 such as fever, pain, poison (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. In addition, there is an interaction between acute and chronic symptoms of brain dysfunction. Delirious states are more easily produced in people already suffering from underlying chronic brain dysfunction. A very common cause of delirium in elderly people is a urinary tract infection, which is easily treatable with antibiotics. Delirium, like mental confusion, is a very general and nonspecific symptom of organ dysfunction. In addition to many organic causes relating to a structural defect or a metabolic problem in the brain, there are also some psychiatric causes, which may also include a component of mental or emotional stress, mental disease.

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.[1][2]


List of Commonly Prescribed Medicines Attributing to Delirium

Common Causes of Delirium

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

References

  1. ↑ Farah, Julia de Lima; Lauand, Carolina Villar; Chequi, Lucas; Fortunato, Enrico; Pasqualino, Felipe; Bignotto, Luis Henrique; Batista, Rafael Loch; Aprahamian, Ivan (2015). "Severe Psychotic Disorder as the Main Manifestation of Adrenal Insufficiency". Case Reports in Psychiatry. 2015: 1–4. doi:10.1155/2015/512430. ISSN 2090-682X.
  2. ↑ Clegg, A.; Young, J. B. (2010). "Which medications to avoid in people at risk of delirium: a systematic review". Age and Ageing. 40 (1): 23–29. doi:10.1093/ageing/afq140. ISSN 0002-0729.
  3. ↑ Alagiakrishnan, K (2004). "An approach to drug induced delirium in the elderly". Postgraduate Medical Journal. 80 (945): 388–393. doi:10.1136/pgmj.2003.017236. ISSN 0032-5473.
  4. ↑ Mavrommati, K; Sentissi, O (2013). "Delirium as a result of vitamin B12 deficiency in a vegetarian female patient". European Journal of Clinical Nutrition. 67 (9): 996–997. doi:10.1038/ejcn.2013.128. ISSN 0954-3007.
  5. ↑ Markowitz JD, Narasimhan M (October 2008). "Delirium and antipsychotics: a systematic review of epidemiology and somatic treatment options". Psychiatry (Edgmont). 5 (10): 29–36. PMC 2695757. PMID 19724721.

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