Potentially life threatening causes of delirium

Potentially life threatening causes of delirium

What are the potentially life-threatening causes of delirium and how can they be recalled? 

The potentially life-threatening causes of delirium are discussed in this table and can be recalled by the mnemonic WHHHHIIMPS.

Potentially life threatening causes of delirium

ernicke’s encephalopathyClinical triad: change in mental status, gait instability, ophthalmoplegiaThiamine 500 mg IM (may see improvement over the course of hours)
ypoxiaOxygen saturation/ABGsTreat etiology
ypoglycemiaBlood glucosePO/IV administration of glucose, dextrose, sucrose, or fructose
ypertensive encephalopathyBlood pressureAntihypertensive medication
yperthermia/hypothermiaTemperatureCooling or warming interventions
ntracerebral hemorrhageMRI/CTPer hemorrhage type/location
nfectious process (e.g., sepsis, bacteremia, subacute bacterial endocarditis)Infectious workupTreat infectious agent/site
eningitis/encephalitisLP, MRIAntibiotic medication
etabolic (e.g., chemical derangements, renal failure, hepatic failure, thyroid dysfunction)Laboratory investigationsPer derangement
oisoning/toxic reaction (e.g., environmental exposures, medications, alcohol, illicit substances)Toxicology panelPer toxin
tatus epilepticusEEGIV benzodiazepines and/or anticonvulsants

ABGs , Arterial blood gases; CT , computed tomography; EEG , electroencephalogram; IM , intramuscular; IV , intravenous; LP , lumbar puncture; MRI , magnetic resonance imaging; PO , oral (per os).


Adapted from Prager LM, Ivkovic A. Emergency psychiatry. In Stern TA, Fava M, Wilens TE, Rosenbaum JF, editors. Massachusetts General Hospital Comprehensive Clinical Psychiatry. London, Elsevier, p. 943 (Table 88-1), 2016.


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