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alwaleed

Acute confusional state

11 posts in this topic

some doubts

If we get an acute confusional state, after going through the normal routine and coming to the management. do we treat the acute stage in the medical ward like nursing in a well lit room, low stimulation etc and then we transfer to the psych ward for treatment of alcohol problems for e.g? or from the start we lounch into detox treatment? :-/

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There are 2 ways of doing this:

The first way is to launch into immediate medical management as if the patient is in front of you ie I would advise the medics to manage him in an appropriately lit area etc and I would accept the transfer only when he is medically fit. We have to then treat the underlying disorder if the confusional state was sec to a psych illness

The other way is that the examiner will guide you (if at all) to the second bit and then you miss the first bit and start with the mx of the disorder

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what if he is withdrawing? shall we detox in the medical ward or transfer to psychy ward? sorry foe these last minutes doubts

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Alcohol withdrawal is a medical emergency. Patients are at high risk of having convulsions when they are withdrawing. Also we may have to use Pabrinex, during which time they are at risk of having anaphylactic reactions. I would say, I wish to to treat them in medical setting. This will involve liaising with medical team.

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If the acute confusional state is secondary to alcohol withdrawal, then managing the withdrawal is part of the detox...

The management will include

1. Full investigations including LFT, RFT and alcohol markers

2. Benzo's depending on the LFTs..... short acting benzos which use minimal liver fn like oxazepam or loraz is preferred in deranged LFT... Usually benzos are enough for the confusion and seizures... dont need to start on anticonvulsants for withdrawal seizures..

3. Thiamine shud be started at 100 to 200 mg daily initially parenterally to prevent WE

4. Hydrate, correct electrolyte imbalance if any...

5 Nursing care... lighting etc etc etc

Usually as Ac Conf state is a medical emergency, it is treated in the medical unit...

Once the detox is done, then go in for the rest of the de addiction treatment...

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Causes of delirium........

I watch death

Infection

Withdrawal

Acute metabolic

Trauma

CNS pathology

Hypoxia

Deficiencies

Endocrinological

Acute vascular events

Toxins and drugs

Heavy metals

NOTP

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Nice one, Dorian! That's really useful.

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Dorian that was realy good. Can i ask you a bit more. Can you give Eg for each one . Like metabolic- Hypo and hper glycemia.... ect. I have made a list for some of them but strugling with few like the CNS.

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I wonder if Parkinson's would count for that- just thinking about the fluctuation you get with Lewy body dementia....is there any evidence that this is an inflammatory thing causing delerium?

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Causes of Delirium:

I1.ntoxication with drugs eg: anticholinergics,anti parkisonism ,steriods , cemetidine,opiates,sedative hypnotics, alcohol ,illicit drugs.

2.withdrawl from alcohol,sedative hypnotics, barbiturates.

3.metabolic causes:hypoxia, hypoglycaemia,hepatic,renal and pulmonary insufficiency.

hypo or hyper thyroidism

hypo or hyper parathyroidism

hypopituitarism

fluid and electrolyte imbalance

porphyria

carcinoid syd

4.infections

5.head injury

6.epilepsy : ictal ,interictal and postictal

7.neoplastic disease

8.vascular disorders:

CVA,TIA,MIGRAINE,EMBOLISM,MI,CCF

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Dorian that was realy good. Can i ask you a bit more. Can you give Eg for each one . Like metabolic- Hypo and hper glycemia.... ect. I have made a list for some of them but strugling with few like the CNS.

Anything under the sun...

CNS pathology would be tumor, meningitis, encephalitis....

Infections - UTI, RTI, endocarditis, septicemia, anything....

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