From the Guidelines
The initial approach to managing acute confusion involves identifying and treating the underlying cause while ensuring patient safety, as supported by the most recent study 1 from 2023.
Initial Assessment
Begin by conducting a thorough assessment including vital signs, physical examination, mental status evaluation, and review of medications. This comprehensive assessment is crucial in identifying potential underlying causes of acute confusion, such as infections, medications, or other medical conditions.
Laboratory Tests and Neuroimaging
Order appropriate laboratory tests such as complete blood count, electrolytes, glucose, renal and liver function tests, urinalysis, and consider neuroimaging if indicated, as suggested by the study 1 from 2019. These tests can help identify underlying causes of acute confusion, such as metabolic disturbances or neurological disorders.
Non-Pharmacological Interventions
Implement non-pharmacological interventions including reorientation strategies (clocks, calendars, familiar objects), ensuring adequate hydration and nutrition, promoting normal sleep-wake cycles, encouraging family presence, and addressing sensory deficits with glasses or hearing aids. These interventions are supported by the study 1 from 2018, which highlights the importance of non-pharmacological approaches in managing delirium.
Medications
Medications should be used sparingly, with low-dose antipsychotics like haloperidol 0.5-1mg orally or intramuscularly being preferred for severe agitation that poses safety risks, as recommended by the study 1 from 2018. Benzodiazepines should generally be avoided except in alcohol withdrawal, due to their potential to worsen delirium.
Safety and Environment
Maintain a safe environment by providing appropriate supervision, removing potential hazards, and using the least restrictive measures necessary. This approach is supported by the study 1 from 2014, which emphasizes the importance of creating a safe and supportive environment for patients with acute confusion.
By following this comprehensive approach, healthcare providers can effectively manage acute confusion, minimize complications, and support recovery of normal cognitive function, ultimately improving patient outcomes and reducing morbidity and mortality.
From the Research
Initial Approach to Managing Acute Confusion
The initial approach to managing acute confusion, also known as delirium, involves a thorough patient history and physical examination to identify the underlying cause of the confusion 2.
Importance of Patient History and Physical Examination
The patient history and physical examination are crucial in selecting relevant diagnostic testing, leading to a timely and accurate diagnosis 2. This process helps protect patients from the risks of unnecessary testing and is cost-effective.
Diagnostic Evaluation
The diagnostic evaluation of acute confusion may involve a variety of tests, including laboratory tests and diagnostic imaging. The goal of these tests is to identify the underlying cause of the confusion and to rule out other potential causes.
Potential Causes of Acute Confusion
Acute confusion can be caused by a variety of factors, including:
- Drug intoxications 3
- Metabolic disturbances 3
- Traumatic brain injury 3
- Acute kidney injury 4
- Systemic illnesses, such as sepsis or cardiac surgery 4
Management of Acute Confusion
The management of acute confusion involves treating the underlying cause of the confusion. This may involve:
- Stabilization of airway, breathing, and circulation 3
- Fluid resuscitation 4
- Avoidance of nephrotoxic medications and contrast media exposure 4
- Correction of electrolyte imbalances 4
- Renal replacement therapy (dialysis) in severe cases 4
Higher Order Thinking in Differential Diagnosis
Differential diagnosis is a systematic process used to identify the proper diagnosis from a set of possible competing diagnoses 5. Higher order thinking is required to evaluate the clinical utility of tests and measures and to implement these findings in clinical practice 5.