Delirium follow

Ruttenber, A.J., Lawler-Haevener, J., Wetli, C.V., Hearn, W.L., and Mash, D.C. Fatal excited delirium following cocaine use epidemiologic findings provide evidence for new mechanisms of cocaine toxicity. J. Forensic Toxicol. 42 25, 1997. 

Delirium (following overdosage, particularly in elderly patients)... 

Heritch AJ, Capwell R, Roy-Byrne PP. A case of psychosis and delirium following withdrawal from triazolam. J Clin Psychiatry 1987 48 168-169. 

Emetics, when administered in small doses, act as expectorants and are used in inflammatory conditions of the respiratory tract to increase the bronchial secretion and render it less tenacious. The most commonly used expectorants are ipecac, ammonium chloride, and apomorphine. The last named is administered in doses of 1 mg in the form of an elixir or syrup. Apomorphine injected in subemetic doses of 1 to 2 mg is also used as a sedative in the delirium following anesthesia, in acute alcoholic psychosis, and in patients manifesting severe agitation prior to anesthesia. 

Effects Leaves similar to D. inoxia. Seeds cause mental confusion, delirium followed by fitful sleep with colorful hallucinations. 

A 38-year-old woman who had tolerated lithium for 20 years developed delirium following a manic episode, despite therapeutic concentrations of lithium (0.7-1.0 mmol/1) the episode remitted fully after lithium was withdrawn (230). 

A 69-year-old man developed acute benzodiazepine withdrawal delirium following a short course of flunitrazepam after an acute exacerbation of chronic obstructive pulmonary disease. He was not an alcohol-or drug-abuser and he had not previously taken benzodiazepines. Six days after withdrawal of flunitrazepam he became agitated and confused, and had visual hallucinations, disorganized thinking, insomnia, increased psychomotor activity, disorientation in time and place, and memory impairment. Tachycardia and significant anxiety were also noted. He fulfilled the DSM IV criteria for withdrawal syndrome and delirium, and had spontaneous remission of symptoms within 48 hours. 

Lin C-E, Mao W-C. Mania complicated with delirium following cessation of longterm lithium therapy. Gen Hosp Psychiatry 2010 32(1) 102-4. 

Drug-drug interaction A case of delirium following prescription of celecoxib in an elderly patienf whose mental state was controlled by fluvoxamine for several years was reported [38 ]. 

Cessation of prolonged heavy alcohol abuse may be followed by alcohol withdrawal or life-threatening alcohol withdrawal delirium. Typical withdrawal symptoms are autonomic hyperactivity, increased hand tremor, insomnia and anxiety, and are treated with benzodizepines and thiamine. Alcoholism is the most common cause of thiamine deficiency and can lead in its extreme form to the Wernicke s syndrome that can be effectively treated by high doses of thiamine. 

Assess for the presence of the following clinical features ° Agitation, altered mental status, delirium, diaphoresis,... 

When fever resolves, it is followed by marked fatigue and drowsiness, warm dry skin, tachycardia, cough, headache, nausea, vomiting, abdominal pain, diarrhea and delirium, anemia, and splenomegaly... 

The answers arc 488-d, 489-h. (Katzang, pp 108-112, 1020.) Atropine blocks muscarinic cholinergic transmission in the brain and in the autonomic nervous system. The result is dry mouth, thirst, dry and hot skin, tachycardia, urinary retention, ataxia, restlessness, excitement, and hallucinations, followed by stupor, delirium, respiratory depression, coma, and death. 

Signs and Symptoms Symptoms include sudden onset of intense headache, fever, nausea, vomiting, and sensitivity to light (photophobia) followed by central nervous system abnormalities such as stupor, tremors, delirium, focal epilepsy and flaccid paralysis (especially in the shoulder), and coma. Recovery is prolonged. Sequelae may include paralysis of the upper extremities and back. 

Tetraalkylleads are highly lipid, soluble, rapidly metabolized and readily cross the blood-brain barrier. These physicochemical properties make the central nervous system the main site of the toxic action of the alkyllead species138. The earliest symptoms include insomnia, which may be followed by lack of appetite, nausea, vomiting, diarrhea hallucinations, delusions, delirium and ultimately death141. Continuing exposure may lead to complaints associated with central nervous system disturbances141. 

The FDA has received 103 reports, occurring between August 29, 2005, and July 6,2006, of delirium, hallucinations, and self-injury in pediatric patients (mostly from Japan) following treatment with oseltamivir. 

Historians have described the consequences of mass intoxication as early as in the last half-century BC, when Antony s army was exposed to belladonna by an enemy force and experienced both delirium and deaths, according to Plutarch and case reports. A summary of some of his findings follows. 

Delirium tremens (the D.T.s ) resulting from alcohol withdrawal is slightly different in that it is usually preceded by the shakes, convulsions and occasionally by alcoholic hallucinosis - characterized by accusatory auditory hallucinations. As observed 60 years ago by Maurice Victor, an expert on alcohol problems, delirium tremens usually does not appear until day 3 or 4 following abrupt withdrawal from alcohol. The patient is generally malnourished and grossly deficient in vitamin Bj (thiamine) as the result of a diet consisting of little but alcohol. This deficiency ftirther compromises mental function. 

Comment Blake is now fully delirious and will continue to be out of touch with reality for many hours, although brief moments of lucidity do occur from time to time. This is a characteristic feature of delirium - variability and occasional awareness of the environment, sometimes with surprisingly appropriate comments or behavior followed by a prompt lapse into total disorientation. As opposed to the normal awake state, in which thoughts and inner stimuli are sometimes distracting, in delirium, the opposite is the case the inner world (although confused) is sometimes invaded by the outer world. 

Comment After approximately 72 hours with little sleep, Burns is now intermittently in contact with his surroundings. He will spend much of the next 24 hours alternating between periods of sleep and semi-oriented wakefulness. Some episodes of delirium will continue, followed by a rapid return of awareness and improvement on his Number Facility and Speed of Closure scores, as well as his ability to conceptualize and draw a normal picture of a man. Incapacitation was longer in this case than in most, by at least 24 hours. A graphical illustration of his time course appears at the end of this chapter. 

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