Delirium is an acute, fluctuating disturbance of attention and awareness caused by an underlying medical problem, a medicine or withdrawal. It is common in older and hospitalized patients and raises the risk of falls, longer stays and death.
Key symptoms
- Sudden confusion that comes and goes during the day
- Poor attention and disorganized thinking
- Agitation, or a quiet hypoactive form with drowsiness
- Hallucinations and a reversed sleep-wake cycle
What you find on exam
- Confusion Assessment Method (CAM) screen
- Attention test such as months of the year backward
- Vital signs, hydration, signs of infection, pain or urinary retention
- Neurologic exam for focal signs
- Review of medicines, alcohol and sedatives
Tests
- Glucose, electrolytes, kidney and liver tests, blood count
- Urinalysis, chest X-ray and cultures if infection is suspected
- ECG and oxygen saturation; blood gas if needed
- CT head after a fall, with focal signs or when no other cause is found
Treatment basics
- Find and treat the cause
- Stop or reduce drugs that worsen delirium (anticholinergics, benzodiazepines, opioids)
- Nondrug care: reorientation, glasses and hearing aids, sleep, mobility, family presence
- Low-dose haloperidol only for severe distress or danger, not routinely
- Benzodiazepines only for alcohol or benzodiazepine withdrawal
Red flags
- Abnormal vital signs or low oxygen
- Falling level of consciousness
- Delirium with fever and stiff neck, or after a head injury
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.