All doctors in the course of their career faced patients in a state of delirium, and the knowledge of the danger it poses to patients and helps to improve the early diagnosis of this syndrome. The prevalence of delirium among adults in the general population over 55 years is 1.1%. From 10 to 40 % of hospitalized elderly patients and 60 % of nursing homes older than 75 years suffer from delirium. Patients suffering from cancer, AIDS, or are in a terminal state, and had undergone surgery for bone marrow transplantation and other surgical procedures are at increased risk of delirium.
The most common pathophysiological mechanism of delirium is a common dysfunction of neurons in the cortex and subcortical structures, leading to the appearance in the patients mainly generalized neurological disorders. Range of causes of delirium includes both widespread states (metabolic) and more rare ones (acute intermittent porphyria). Most of these conditions are reversible with timely treatment and have a good prognosis.
Vital dysfunctions require intensive care.
Hypertension due to dehydration, sepsis, cardiac arrhythmia, heart failure requires timely recognition and appropriate treatment to prevent the deepening of neurological and somatic disorders.
Tachycardia may be a manifestation of infection, cardiac disorders, hyperthyroidism, dehydration, withdrawal, intoxication, or symptoms of sympathetic overactivity in delirium.
Hypoventilation due to pneumonia or an overdose of medication can lead to hypoxia or hypercapnia.
Increased body temperature is observed in infections, abstinence, hyperthyrosis. Hypothermia occurs when sepsis and overdose of barbiturates.
Stiff neck is a sign of irritation of the meninges, which is usually caused by infections of the central nervous system and SAH. Meningitis, encephalitis, and in the presence of SAH rigidity of the neck muscles should be avoided in the first place.
In all cases, the confusion must be inspected for signs of trauma to the head (scalp, depressed skull fractures, gemotimpanum). Particularly important is to avoid liquorrhea as in such cases there is a risk of bacterial meningitis.
Pus from the nasal passages or gray fixed eardrum may indicate, respectively, sinusitis or otitis media. The nasal septum should also examined for the detection of erosions, which are observed in the use of cocaine.
It is necessary to examine the skin (the presence of cyanosis, hirsutism, hyperpigmentation, and squamous dermatitis ). All patients should be checked for signs of intravenous injections.
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