Acute Confusion

CLINICAL DIAGNOSTIC MANUAL

Acute confusion, also known as delirium, is a state of mental alteration characterised by a rapid onset of disorientation, disorganised thinking, and reduced awareness of the environment. This condition can be alarming for both the patient and caregivers, as it can arise suddenly and significantly impact the individual’s ability to perform daily activities and communicate effectively. Identifying and treating the underlying cause of acute confusion is crucial to improving the patient’s prognosis.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmed Diagnosis
Sepsis secondary to urinary infection	Fever, chills, lower back pain, increased urinary frequency, confusion	Symptoms of urinary infection accompanied by systemic signs of sepsis	Urinalysis, urine culture, blood cultures, sepsis blood markers
Hypoxia	Shortness of breath, cyanosis, agitation, confusion, tachycardia	History of respiratory or cardiovascular disease, signs of respiratory distress	Arterial blood gas analysis, pulse oximetry
Alcohol withdrawal syndrome	Tremor, sweating, anxiety, hallucinations, confusion	History of chronic alcohol use and recent abstinence	Clinical evaluation, blood alcohol tests, withdrawal scales
Post-ictal state	Confusion, fatigue, muscle pain, amnesia, headache	History of recent seizure	Clinical evaluation, EEG
Thiamine deficiency	Confusion, ataxia, ophthalmoplegia, peripheral neuropathy	History of malnutrition or alcoholism	Blood thiamine levels, response to thiamine supplementation
Hypothyroidism	Fatigue, weight gain, dry skin, cold intolerance, bradycardia, confusion	History of hypothyroid symptoms	Blood TSH and free T4 levels
Thyrotoxicosis	Weight loss, tachycardia, tremor, heat intolerance, anxiety, confusion	History of hyperthyroid symptoms	Blood TSH and free T4 levels, thyroid antibodies
Hypoglycaemia	Sweating, tremors, tachycardia, hunger, confusion, loss of consciousness	History of diabetes or insulin use, hypoglycaemia symptoms	Blood glucose levels
Adrenal insufficiency	Fatigue, weight loss, hyperpigmentation, hypotension, confusion	History of adrenal insufficiency symptoms	Blood cortisol and ACTH levels, ACTH stimulation test
Frontal lobe injury	Personality changes, impaired judgement, apathy, confusion, difficulty planning	History of trauma or focal neurological signs	Brain imaging (MRI or CT)
Medication or drug effects	Varies by substance, may include sedation, agitation, hallucinations, confusion	History of recent medication or drug use, symptoms consistent with side effects	Toxicology tests, medication history review