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• Delirium, acute confusional state, acute cognitive impairment, acute encephalopathy, altered mental status and other synonyms all refer to transient disorder with impairment of attention and cognition.

• Delirium is associated with increased mortality and prolonged ICU stay.

• Patients with preexisting dementia; history of hypertension and or alcoholism and a high severity of illness at admission.

Pathologic mechanism producing delirium are complex and are thought to involve wide spread neuronal or neurotransmitter dysfunction. Four general cause are

• Primary intracranial disease

• Systemic disease secondarily affecting the CNS

• Exogenous toxin

• Drug withdrawal

Clinical Feature

• Delirium or acute confusional state generally develops over days.

• Attention, perception, thinking and memory are all altered.

• Patient may fluctuate rapidly between hypoactive and hyperactive state.

• Sleep wake cycles are disrupted, with increased somnolence during day and agitation at night.

• Tremor, asterixis, tachycardia, sweating, hypertension & emotional outburst may be present.

• Hallucination tend to be visual, although auditory hallucination can also occur.

Treatment

• Adequate lighting and psychosocial support

• Haloperidol 5 – 10mg PO, IM or IV ; 1-2 mg in elderly is been used routinely but there is no evidence.

• Bezodiazipine like lorazepam can be used 0.5 – 2.0 mg PO,IM or IV.