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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
| Condition | Diagnostics | Treatment |
|---|---|---|
| W ernicke’s encephalopathy | Clinical triad: change in mental status, gait instability, ophthalmoplegia | Thiamine 500 mg IM (may see improvement over the course of hours) |
| H ypoxia | Oxygen saturation/ABGs | Treat etiology |
| H ypoglycemia | Blood glucose | PO/IV administration of glucose, dextrose, sucrose, or fructose |
| H ypertensive encephalopathy | Blood pressure | Antihypertensive medication |
| H yperthermia/hypothermia | Temperature | Cooling or warming interventions |
| I ntracerebral hemorrhage | MRI/CT | Per hemorrhage type/location |
| I nfectious process (e.g., sepsis, bacteremia, subacute bacterial endocarditis) | Infectious workup | Treat infectious agent/site |
| M eningitis/encephalitis | LP, MRI | Antibiotic medication |
| M etabolic (e.g., chemical derangements, renal failure, hepatic failure, thyroid dysfunction) | Laboratory investigations | Per derangement |
| P oisoning/toxic reaction (e.g., environmental exposures, medications, alcohol, illicit substances) | Toxicology panel | Per toxin |
| S tatus epilepticus | EEG | IV 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).
Sources
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.
