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Delirium is an acute, fluctuating disturbance in consciousness and cognition that develops rapidly over hours to days. It represents a medical emergency requiring immediate identification and treatment of underlying causes, as it significantly increases morbidity, mortality, and healthcare costs.
Delirium results from widespread disruption of neuronal networks due to systemic inflammation, neurotransmitter imbalances (particularly acetylcholine deficiency and dopamine excess), and metabolic dysfunction. Multiple precipitating factors including infections, medications, metabolic disturbances, and surgical stress overwhelm the brain's compensatory mechanisms, leading to altered consciousness and cognitive impairment.
Early recognition requires systematic screening using validated tools like CAM-ICU or 4AT, focusing on acute onset, fluctuating course, inattention, and altered consciousness. Management involves identifying and treating underlying causes while providing supportive care including orientation techniques, sleep hygiene, early mobilization, and minimizing sedating medications to prevent complications and promote recovery.