Confusion is a behavioural state of reduced mental clarity, coherence, comprehension and reasoning. The causes may be organic or psychiatric (the reader is referred to a textbook of psychiatry for these conditions). The organic causes are listed below. Sudden onset of confusion may be precipitated by head injuries, epilepsy, stroke and metabolic disorders. Systemic infection, systemic disease and cerebral metastasis tend to pursue a more gradual onset. Diabetes is associated with abnormalities of glucose levels with hyperglycaemia resulting from poor diabetic control and hypoglycaemia developing due to drug administration error, missing meals or unaccustomed exercise. A history of thyroid disorder is very relevant and confusion can result from both hyper- and hypothyroidism (myxoedema madness). The presence or carcinoma may precipitate confusion as a result of cerebral metastasis or the development of hypercalcaemia of malignancy. Encephalopathy is a feature of both liver failure and thiamine deficiency. Renal disease can lead to confusion from uraemic encephalopathy or as a result of electrolyte disorders. Hypoxia may result from cardiac failure and respiratory disease. Confusion associated with folate deficiency. Check for folate in the diet, alcohol disease, coeliac disease, inflammatory bowel disease, pregnancy.
Confusion
History
Onset
Past medical history
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