Diagnosis of Acute Confusional State (Delirium)

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


1. Laboratory investigations: They are done in all cases with delirium:

  • Complete blood counts
  • Routine blood biochemistry e.g. sugar, acetone, electrolytes
  • Liver and kidney function tests
  • ECG and X-ray chest
  • Arterial blood gas analysis

2. Additional tests indicated on suspicion of specific conditions:

  • Urine and blood culture and sensitivity
  • Blood levels of drugs and their estimation in urine
  • Serum folate, Vitamin B12 levels, ammonia
  • HIV testing
  • Urinary porphyrins
  • Test for endocrinological disorders (T3, T4, TSH, LH, FSH, cortisol)
  • EEG: Diffuse slowing of EEG has a good correlation with diagnosis of delirium but absence of EEG abnormalities does not rule out the diagnosis. Fast activity is seen in benzodiazepine and alcohol withdrawal delirium.
  • Imaging e.g. CT scan, MRI etc. for neurological disorders
  • CSF analysis: Lumbar puncture should be attempted only after exclusion of mass lesion on CT and if infected etiology of delirium is suspected.

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