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Zyloprim (Allopurinol)

Acute confusion in the elderly is a very common condition. ‘Acute’ can mean anything from something lasting only a few minutes to a state lasting up to three months. The point that must be stressed again and again, however, is that confusion is not dementia and that acute confusion in an old person is simply that person’s way of presenting with an illness. The vast majority of acute con-fusional states in old people are fully reversible.
What do we mean by acute confusion? One of the best descriptive words for it is ‘delirium’. One can then picture the sufferer being disorientated in time and place: they are not sure where they are and what time of day it is. Their mood is up and down, one minute calm and happy to cooperate and the next agitated and wanting to do inappropriate things. This is often called labile mood. The person’s memory is usually poor and they can be quite drowsy at times. One of the most distressing features is the tendency to hallucinations and delusions. Hallucinations occur more easily if the person has poor eyesight and hearing, but they also tend to happen when the light is poor (the twilight times of dawn and evening). The condition of confusion occurring at twilight has been termed sundowner syndrome. Common objects get mistaken for something more sinister – the pattern on the carpet becomes a mass of crawling insects. Delusions are wrong ideas that the deluded person will not accept as wrong; you can talk and explain until you are blue in the face but the sufferer will still insist that they are right. Delusions can take many forms but in acute confusion they are usually short-lived. They may be slightly comical in that the sufferer insists that a number 48 bus is due in their bedroom any minute to take them to the shops. Sometimes they are more distressing, especially when the person insists, for example, that their food is poisoned or that one of their carers is going to harm them. These are known as paranoid delusions, paranoia being a mental state where you wrongly think that you are going to be harmed.
People with acute confusional states are not usually aggressive. Occasionally violence in the form of hitting out occurs, usually as the result of the confused person being restrained from doing something which is going to be harmful to them. If agitated, the person’s speech is often affected; sentences don’t get finished as they rush onto something else, or the drowsiness can make the speech a little slurred. Conditions that cause confusional states to come on very suddenly (such as infections) often cause the person to look and feel unwell. They may be flushed and warm to the touch, even sweating. They may complain of very vague aches and pains as well as having no appetite. Nausea and vomiting can occur and the confusion may be accompanied by weakness and lethargy. Sometimes no other symptoms occur and yet an underlying illness is still present.

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