A variety of conditions may contribute to an altered mental status for a patient in the Intensive Care Unit (ICU). The change may range from minor confusion to delirium to psychosis. All reversible causes should be identified and treated if possible.


Drug, chemical or alcohol related:

(1) alcohol or drug withdrawal

(2) adverse drug reaction

(3) drug-drug interaction

(4) toxic encephalopathy


Metabolic problem:

(1) electrolyte abnormalities

(2) metabolic encephalopathy (including hepatic encephalopathy)

(3) hypoglycemia


Neurologic disorder:

(1) dementia

(2) pre-existing psychosis

(3) intracerebral vascular accident or hemorrhage (stroke, subdural hematoma, subarachnoid hemorrhage)

(4) infectious encephalopathy (encephalitis, other)

(5) post-ictal


Acute disease:

(1) sepsis

(2) hypoxia

(3) pain untreated or inadequately treated


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