TAILIEUCHUNG - Chapter 026. Confusion and Delirium (Part 5)

Abbreviations: LSD, lysergic acid diethylamide; GHB, γ-hydroxybutyrate; PCP, phencyclidine; CNS, central nervous systemPrescribed, over-the-counter, and herbal medications are common precipitants of delirium. Drugs with anticholinergic properties, narcotics, and benzodiazepines are especially frequent offenders, but nearly any compound can lead to cognitive dysfunction in a predisposed patient. While an elderly patient with baseline dementia may become delirious upon exposure to a relatively low dose of a medication, other lesssusceptible individuals may only become delirious with very high doses of the same medication. This observation emphasizes the importance of correlating the timing of recent medication changes, including dose and formulation, with. | Chapter 026. Confusion and Delirium Part 5 Abbreviations LSD lysergic acid diethylamide GHB y-hydroxybutyrate PCP phencyclidine CNS central nervous systemPrescribed over-the-counter and herbal medications are common precipitants of delirium. Drugs with anticholinergic properties narcotics and benzodiazepines are especially frequent offenders but nearly any compound can lead to cognitive dysfunction in a predisposed patient. While an elderly patient with baseline dementia may become delirious upon exposure to a relatively low dose of a medication other less-susceptible individuals may only become delirious with very high doses of the same medication. This observation emphasizes the importance of correlating the timing of recent medication changes including dose and formulation with the onset of cognitive dysfunction. In younger patients especially illicit drugs and toxins are common causes of delirium. In addition to more classic drugs of abuse the recent rise in availability of so-called club drugs such as methylenedioxymethamphetamine MDMA ecstasy y-hydroxybutyrate GHB and the PCP-like agent ketamine has led to an increase in delirious young persons presenting to acute care settings. Many common prescription drugs such as oral narcotics and benzodiazepines are now often abused and readily available on the street. Alcohol intoxication with high serum levels can cause confusion but more commonly it is withdrawal from alcohol that leads to a classic hyperactive delirium. Alcohol and benzodiazepine withdrawal should be considered in all cases of delirium as even patients who drink only a few servings of alcohol every day can experience relatively severe withdrawal symptoms upon hospitalization. Metabolic abnormalities such as electrolyte disturbances of sodium calcium magnesium or glucose can cause delirium and mild derangements can lead to substantial cognitive disturbances in susceptible individuals. Other common metabolic etiologies include liver and renal failure

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