Delirium is a topic covered in the 5-Minute Emergency Consult.

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  • Delirium is a clinical syndrome characterized by acute changes in awareness, cognition, and perception with a waxing and waning course.
  • Delirium is a syndrome secondary to an underlying medical condition.
  • Pathophysiology unknown:
    • Diffuse cerebral dysfunction
    • Derangements of cerebral acetylcholine
    • CNS dopamine, γ-aminobutyric acid, and serotonin may be involved.
  • Frequently missed by emergency medicine physicians due to atypical chief complaints.
  • Associated with increased mortality for inpatients and increased length of stay.


  • Neurologic:
    • Meningitis or encephalitis
    • Seizure
    • Wernicke encephalopathy
    • Hypoxia and hypoperfusion of the brain
    • Intracranial bleed or mass
  • Pulmonary:
    • Pneumonia
    • Other pulmonary etiology of hypoxia
  • Cardiovascular:
    • Hypertensive crisis
    • Acute coronary syndromes
    • Arrhythmia
  • GI:
    • Hepatic encephalopathy
    • Dehydration
  • Renal:
    • UTI
    • Acute renal failure
  • Endocrine:
    • Hypoglycemia
    • Hyperglycemia
    • Hypothyroid
  • Rheumatologic:
    • Collagen vascular disorder
  • Toxicologic:
    • Environmental toxins
    • Medications
    • Withdrawal from barbiturates or alcohol
  • Other:
    • Electrolyte abnormalities
    • Vitamin deficiencies
    • Hypothermia
    • Hyperthermia
    • Trauma

Geriatric Considerations
  • Common presentation in older ED patients
  • Up to 10% of older ED patients may have delirium.
  • Many patients will present with subtle symptoms and vague chief complaints:
    • Fall, dizzy, or not feeling well
  • Waxing and waning symptoms
  • Cause may be life-threatening condition.

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