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.