Reference

Guide | Reference

107 Delirium and Acute Confusional States

This chapter starts the rule-out compendium for acute, high-stakes presentations. Most useful when something feels off or time-critical.

Purpose. Prevent catastrophic misses by prioritizing acute confusional states. Flag presentations where psychiatric framing is unsafe.

107.1 Hallmark Signs

Acute onset with fluctuating attention or awareness.
Disorganized thinking, altered level of consciousness.
Visual or tactile misperceptions with waxing/waning course.

107.2 High-Risk Contexts

Older adults, hospitalized patients, recent surgery, infection, withdrawal.
New medications or polypharmacy.

107.3 Minimum Workup (by setting)

ED/inpatient: vitals, glucose, electrolytes, infection screen, medication review. [E0/U2]
Outpatient: urgent referral if acute confusion or fluctuating attention. [E0/U3]

Red flags

Any acute confusion with safety concerns or inability to care for self. [E0/U3]
Rapidly worsening cognition or new neurologic signs. [E0/U3]

Documentation Output. “Delirium ruled out vs rule-out required.” Rationale for referral or immediate workup.