Confusional states

Wernicke s syndrome is a serious consequence of alcoholism and thiamine (vitamin Bx) deficiency. Certain characteristic signs of this disease, notably ophtalmoplegia, nystagmus, and ataxia, respond rapidly to the administration of thiamine but to no other-vitamin. Wernicke s syndrome may be accompanied by an acute global confusional state that may also respond to thiamine. Left untreated, Wernicke s syndrome frequently leads to a chronic disorder in which learning and memory are strongly impaired. This so-called Korsakoff s psychosis is characterized by confabulation, and is less likely to be reversible once established. 

Studies of the intoxicating effects of toluene showed that the inhalation of its vapor at a concentration of 200 ppm was associated with the development of mild-to-moderate intoxication, characterized by sedation, paresthesias, and hyporeflexia. Toluene vapor concentrations of 600-800 ppm induced a confusional state, whereas greater concentrations produced an intense euphoria (Benignus 1981 Press and Done 1967). In humans, plasma concentrations of toluene of 10-100 pM have been reported to be intoxicating these concentrations are close to the intoxicating concentrations of alcohol and in-halational anesthetics (Miller 1985). 

Suggested Alternatives for Differential Diagnosis Meningitis, basilar artery blood clots (thrombosis), cardioembolic stroke, cavernous sinus syndromes, cerebral venous blood clots (thrombosis), confusional states and acute memory disorders, epileptic and epileptiform encephalopathies, febrile seizures, haemophilus meningitis, intracranial hemorrhage, leptomeningeal carcinomatosis, subdural pus (empyema), or bruise (hematoma). 

The patient experiences anxiety, apathy, bradyphrenia (slowness of thought processes), confusional state, dementia, depression, hallucinosis/psychosis (typically drug-induced), and sleep disorders (excessive daytime sleepiness, insomnia, obstructive sleep apnea, and rapid eye movement sleep behavior disorder). 

Delirium and Allied States, a classic 1935 monograph by Curran and Wolff, lists over 100 possible causes of delirium. Their detailed clinical descriptions of these confusional states would apply equally well to BZ intoxication. 

Adverse reactions include the following anorexia, apprehension, body/joint pain, chest pains, confusion, confusional states/memory impairment, congestion, constipation, coordination disorders, cramps/pain, depression, diarrhea, dreaming/nightmares, dry mouth, dysesthesia, euphoria, Gl pain, GU complaints, headache, heartburn, insomnia, irritability, lack of concentration, nausea, nervousness, palpitations, paresthesia, relaxed feeling, restlessness, tachycardia, taste alterations, tinnitus, tiredness, tremor, vomiting, weakness. 

Psychotic disorders Cautiously treat patients suffering from psychotic disorders, schizophrenia, or confusional states and keep under careful surveillance because exacerbations of these conditions have been observed with oral administration. Autonomic dysreflexia Use with caution in patients with a history of autonomic dysreflexia. The presence of nociceptive stimuli or abrupt withdrawal may cause an autonomic dysreflexic episode. 

Adverse reactions may include headache, somnolence/fatigue, dizziness, confusional states, hallucinations, insomnia, nausea, vomiting, abdominal discomfort, diarrhea, constipation, thrombocytopenia, alopecia, rash, gynecomastia, impotence, loss of libido, and arthralgia. 

Gastro intestinal bleeding, acute pancreatitis, a toxic confusional state, and acute hepatistis/hepatic failure are each possible results of a very heavy drinking binge . Heredity appears to play a major role in the contraction of alcoholism, with recent discoveries of genes that influence vulnerability to this disorder. 

Other adverse effects include orthostatic hypotension, anticholinergic effects which may be severe in elderly patients and acute confusional states. Tolerance develops to the hypotensive and anticholinergic effects. 

Transient agitated confusional state, chemical phlebitis and thrombosis near site of injection... 

Lipowski, Z.J. (1990) Delirium Acute Confusional States. New York Oxford University Press. 

Aggressive behavior can occur during agitated and confusional states in children and adolescents suffering... 

It is indicated in mental retardation and learning problems in children, confusional state in old age, cerebrovascular accidents. 

Adverse reactions include nausea, vomiting, fatigue, diarrhoea and abdominal pain, rashes including photosensitivity, urticaria, pruritus, increase in blood urea and creatinine, reversible rise in bilirubin and liverrelated enzymes. Neurological adverse effects are headache, dizziness, confusional state, hallucinations, sorrmolence and convulsions. 

It is indicated in wet beriberi, dry beriberi, Wernicke s encephalopathy, prophylaxis of thiamine deficiency, hyperemesis gravidarum, Korsakoff s syndrome, chronic alcoholics, multiple neuritis, toxic and confusional states, delirium tremens and anorexia nervosa. 

Use of androgenic steroids is likely to produce a sensation of energy and euphoria, but also with a tendency to sleeplessness and irritability (1). More extreme changes in mental state can result in extreme swings in mood, ranging from depression to aggressive elation. An unusual complication in one case was a toxic confusional state and choreiform movements caused by an anabolic steroid (SED-12, 1038) (29), but it may have been due to the non-specific results of endocrine stress in a susceptible individual. 

Tilzey A, Heptonstall J, Hamblin T. Toxic confusional state and choreiform movements after treatment with anabolic steroids. BMJ (Chn Res Ed) 1981 283(6287) 349-50. 

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