A person suffering from delirium experiences sudden mental disturbance in cognitive thinking that fluctuates. If a person normally has a mental impairment, delirium causes a worsening of that state. Delirium results from a number of conditions, including systemic infection, cerebral tumor, medication reaction, poisoning, drug intoxication or withdrawal, seizures and head injuries, according to "Dorland’s Illustrated Medical Dictionary." However, when a metabolic disturbance occurs as in a urinary tract infection, the UTI can cause delirium as well.
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Prevalence of UTI
The prevalence of UTI increases with a person’s age. Commonly seen in both sexes, the incidence among elderly women is twice that of men. Women, more often than men, develop no symptoms, according to the 2010 "Merck Manual of Geriatrics." The danger lies in losing the window of early detection when a single bacterium causing the bladder infection could succumb easily to antibiotics. If allowed to persist, the bacteria counts multiply and other bacteria co-infect the bladder. Caring.com states that when people have the infection for a long time, delirium begins suddenly and signals medical personnel to check for UTI.
Features of UTI
Generally, a UTI shows itself by producing burning with urination, abdominal or flank pain, possible bloody urine and sometimes fever. In men, these symptoms can mimic prostate symptoms. People with dementia may miss or dismiss these symptoms altogether and slip closer to infecting the kidneys or the blood and develop sepsis.
Relationship Between UTI and Delirium
The body tries to maintain a state of equilibrium involving all of its processes. When it does succeed in keeping things balanced, the body runs smoothly. Microbes like bacteria take advantage of any weakened area of the body and multiply by feeding off the body’s nutrients, which they find in the bodily fluids. These include many minerals such sodium, potassium, calcium, phosphorus and magnesium. In the body, we call these minerals electrolytes. The disturbance of electrolytes reaches the brain and causes the malfunction known as delirium.
Effects of Delirium
Delirium comes on suddenly. It seems as if the affected person has “lost his mind.” While not lost, his mind goes through a series of misfirings as his brain experiences shortages of electrolytes. The "Diagnostic Statistical Manual," 4th edition, DSM IV, states the delirious person has a reduced ability to maintain attention to external stimuli, shows disorganized thinking, rambles in his speech, experiences sensory misperceptions and hallucinations, memory impairment and disturbance in the sleep-wake cycle. The person seems frightened, paranoid or agitated by this altered state of mind.
Because a UTI can appear without symptoms, it becomes doubly important that caregivers for the elderly have their patients' urine tested at the slightest sign of behavior change. Antibiotics work by lowering the number of bacteria in the bladder or urinary tract, which re-establishes balance in the body’s fluids and electrolytes. Delirium leaves as suddenly as it came on when the offending problem resolves. For all populations, see a physician if any urine symptoms arise. Delay makes the infection harder to treat and can lead to the disruption of body fluids that causes delirium.
REFERENCES & RESOURCES
- "Dorland's Illustrated Medical Dictionary" 31st. ed.; 2007.
- "Merck Manual of Geriatrics"; Urinary Tract Disorders; 2010.
- All Nurses: Geriatric UTI and Hallucinations Psychosis
- Caring: How Dangerous are Urinary Tract Infections in Adults?
- "Current Medical Diagnosis and Treatment"; Stephen McPhee, M.D., & Maxine Papadakis, M.D.; 2010.