Approach to metabolic causes of confusion – a practical guidebook

Presentation of patients in emergency situations can be varied, with confusion being an important management dilemma. Although confusion is usually attributed to neurological conditions, metabolic causes of altered consciousness are important but often overlooked. Moreover, a practical guide for treatment of confusion in patients especially in emergency situations is vital to facilitate prompt management leading to reduction in morbidity and mortality. Therefore, the objective of this study is to design a guidebook for practical approach to patients with confusion due to metabolic conditions. As a result, a guidebook compiling important metabolic causes of confusion, detailing the spectrum of presentation, diagnostic criteria and succinct management algorithms. This novel approach aims to provide medical doctors with a focused and comprehensive guide in dealing with metabolic causes of confusion in a proactive manner as opposed to the traditional reactive method and tailored to local requirements. This guide contains three main metabolic categories: disorders in calcium, sodium and glucose metabolism, with seven subcategories: hypocalcaemia and hypercalcaemia, hyponatraemia and hypernatraemia, hypoglycaemia, and hyperglycaemic emergencies constituting of diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS). The innovation facilitating doctors managing patients in a prompt and focused approach is imperative to prevent complications and reduce mortality. This guidebook is a compendium of the more important metabolic derangements leading to confusion, with practical approach to management, aiming to aid health-care workers to recognize and deliver early and prompt treatment of these conditions