Pathophysiology of Acute Confusional State (Delirium)

In this article, we will discuss the Pathophysiology of Acute Confusional State (Delirium). So, let’s get started.

Pathophysiology

Acute confusional state of metabolic origin occurs due to interruption of energy substrate delivery. The substrate for neuronal functions is oxygen and glucose. The cerebral blood flow carries these substrates to neurons. Therefore, reduced substrate supply such as oxygen (hypoxia), glucose (hypoglycemia) or reduced blood supply (ischemia) or alteration of neurophysiological responses of neurons by drugs or alcohol intoxication, toxic endogenous metabolites, anesthetics or epilepsy produce acute confusional state and coma by widespread neuronal dysfunction in the cortex (cerebral hemisphere and RAS) and reduces all aspects of mentation.

The reversibility of delirium in metabolic encephalopathies (hepatic failure, renal failure, hypercapnia, diabetic and hyperosmolar nonketotic coma, hypothyroidism, Vitamin B12 deficiency, hypothermia) drugs intoxication (CNS depressants and anesthetic) and positictal phenomenon of epilepsy is not fully understood, probably is related to interference in cerebral energy metabolism and abnormalities in neurotransmitters, hence recovery occurs when neural metabolic balance is restored.

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