Can acidosis cause acute delirium?

From the Guidelines

Acidosis can indeed cause acute delirium, as it disrupts normal neuronal function due to its impact on brain pH levels. Acidosis, which refers to the existence of one or more conditions that promote acidemia, can significantly impact brain function and lead to altered mental status, including delirium 1. This occurs because the brain is highly sensitive to changes in pH levels, and acidosis can lead to increased oxidation of branched chain amino acids, increased protein degradation, and decreased albumin synthesis, all of which can contribute to delirium.

Key Points to Consider

• Metabolic acidosis, which can be caused by conditions such as chronic renal failure or diabetic ketoacidosis, is a common cause of acidosis-induced delirium
• Respiratory acidosis, which can be caused by respiratory failure or severe COPD, can also lead to delirium
• Symptoms of acidosis-induced delirium include confusion, disorientation, agitation, hallucinations, and altered consciousness
• Treatment focuses on addressing the underlying cause of acidosis, which may involve insulin and fluids for diabetic ketoacidosis, dialysis for kidney failure, or ventilatory support for respiratory acidosis
• Normalization of serum bicarbonate concentrations, which can be achieved through higher dialysate concentrations or oral supplementation with bicarbonate salts, is essential in managing acidosis and preventing delirium 1.

Management and Prevention

• Regular monitoring of serum bicarbonate levels is crucial in preventing acidosis-induced delirium
• Correction of acidemia due to metabolic acidosis has been associated with increased serum albumin, decreased protein degradation rates, and increased plasma concentrations of branched chain amino acids 1
• Prompt recognition and treatment of acidosis is essential, as severe or prolonged acidosis can lead to permanent neurological damage or even death.

From the Research

Acidosis and Delirium

• Acidosis, particularly metabolic acidosis, can have various causes and consequences, including potentially life-threatening complications 2.
• The relationship between acidosis and delirium is not directly addressed in the provided studies, which primarily focus on the use of haloperidol in treating delirium in critically ill patients.
• However, it is known that metabolic disturbances, including acidosis, can contribute to the development of delirium in critically ill patients.

Etiology of Acute Metabolic Acidosis

• The etiology of acute metabolic acidosis is heterogeneous and can include conditions such as lactic acidosis, metformin-associated acidosis, and hyperchloremic acidosis induced by unbalanced electrolyte preparations 2.
• These conditions can potentially lead to delirium, although the direct link between acidosis and delirium is not explicitly stated in the provided studies.

Management of Acute Metabolic Acidosis

• The management of acute metabolic acidosis involves addressing the underlying cause and may include the use of bicarbonate therapy, although this can have potential side effects 2.
• New therapeutics for controlling acute metabolic acidosis are under development, highlighting the need for further research in this area.

Haloperidol and Delirium

• The provided studies primarily focus on the use of haloperidol in treating delirium in critically ill patients, with mixed results regarding its efficacy and safety 3, 4, 5, 6.
• While haloperidol may be effective in reducing mortality and delirium severity in some cases, the evidence is not conclusive, and more research is needed to fully understand its effects.