• Also known as "acute toxic-metabolic encephalopathy"
  • Delirium vs. dementia vs. psych

Clinical Features

  • Main cognitive impairment is that of inattention (vs memory in dementia)
  • Generally develops over hours to days
  • Symptoms are classically described as fluctuating throughout the day (ie may appear normal in between episodes)

ED Confusion Assessment Method[1]

  • Acute onset of mental status changes and/or fluctuating course
  • Inattention
  • Disorganized thinking
  • Altered level of consciousness

A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria

Differential Diagnosis

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma


General Psychiatric


Main goal is to find the underlying cause

AMS Workup

Common Orders

  • Point of care glucose
  • CBC
  • Chemistry
  • LFTs
  • UA
  • CXR
  • Utox
  • ECG
  • Head CT
  • CAM score

Consider Based on Clinical Situation


  • Treat underlying cause
  • Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features


  • Admission

See Also

  • Altered Mental Status


  1. Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941.
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.