Simple questions become hard to answer in cases of acute confusion

WHAT’S your name? What age are you? Can you count back from 20?

All quite simple questions which you should easily be able to answer.

If you have acute confusion, however, these straightforward queries might be tricky.

I had a house call last week, visiting an elderly lady who was showing signs of being a bit muddled, according to her daughter.

Diagnosing acute confusion – or delirium – can be tough, and it helps if you’ve got someone who knows what the patient is normally like.

The signs can come and go, particularly in milder cases. One moment the patient seems to be chatting away fine, the next they perhaps aren’t quite sure where they are, before seeming to return to normality again seconds later.

This can make diagnosis difficult – and doctors can miss it if they speak to the patient in a more lucid moment.

If someone has become confused, and their lips have turned blue or are experiencing breathing difficulties, then it’s time to seek urgent medical attention.

My patient didn’t seem in any danger, but struggled to count down from 20.

There are plenty of potential causes of acute confusion, making it difficult to diagnose. Diabetes, medication – especially opiates like codeine – can cause it, as can alcohol, an imbalance of salts or a head injury.

The list is extensive. My patient had a urine infection – one of the most common causes among older people.

Hopefully she would be fine after a few days of antibiotics, although I advised her daughter she might have to go to hospital if she got worse.

I advised her not to challenge the confusion too forcefully, and make sure her mother kept taking fluids.