Acute Confusion: Metabolic

• Hypoglycaemia. Rapid recovery after administration of glucose. Check for any use or administration of antidiabetic medication and consumption of Akee fruit (syn. Ackee fruit, Blighia sapida; contains toxic hypoglycines A and B).

• Severe ketoacidosis, usually in diabetes

• Wernicke-Korsakoff’s disease (frequent with alcohol abuse). Acute deterioration can be triggered by intravenous glucose administration. Paresis of the eye muscles, together with ataxia in a patient with confusion and apathy, with recovery after injection of thiamine (vitamin B1), is diagnostic. (cf. beriberi)

• Severe hyponatraemia, such as is occasionally seen in SIADH (Syndrome of Inappropriate Secretion of Antidiuretic Hormone) and in Addisonian crisis (adrenal failure, e.g. after a bite from a Russell’s viper).

• Heat stroke and dehydration. Definitely increased risk in the tropics. Heat illness may be viewed as a continuum of illnesses relating to the body’s inability to cope with heat. It includes minor illnesses, such as heat edema, heat rash (ie, prickly heat), heat cramps, and tetany, as well as heat syncope and heat exhaustion. Heatstroke is the most severe form of the heat-related illnesses and is defined as a body temperature higher than 41°C associated with neurologic dysfunction. Two forms of heatstroke exist. Exertional heatstroke generally occurs in young individuals who engage in strenuous physical activity for a prolonged period of time in a hot environment. Classic nonexertional heatstroke more commonly affects sedentary elderly individuals, persons who are chronically ill, and very young persons. Classic nonexertional heatstroke occurs during environmental heat waves and is more common in areas that have not experienced a heat wave in many years. Both types of heatstroke are associated with a high morbidity and mortality, especially when therapy is delayed. Hypoglycemia, convulsions and rhabdomyolysis can occur as complications of heatstroke.

• Severe hypothyroidism with possible myxoedemic coma. Thyroid problems can get worse after using iodine for drink water decontamination.

• Drunkenness. Beware of methanol contamination of home-brewed liquors.

• Intoxication: acute e.g. CO, cocaine (crack), chronic in e.g. mercury- or thallium intoxication (rat poison). Intoxication with thallium causes hair loss several weeks after the acute poisoning.

Category: Neurology notes , Psychiatry Notes