Delirium physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]


It is important to do a thorough physical examination to find out the underlying etiology of delirium. Systemic physical examination includes testing vital signs such as temperature, pulse rate, blood pressure, and respiration and also evaluation of mental status. Patients may seem disoriented with difficulty in sustaining attention, problem in short-term memory, poor insight and impaired judgment.

Physical Examination

  • Delirium symptom changes in severity during its course.
  • It is essential to assess the patient multiple times, as it is easy to miss a diagnosis, also features like sundowning can be overlooked if the assessment is not done towards the end of the day.

General Examination

  • Temperature:


  • Nutritional status: B12 and folate deficiencies can be assessed on physical examination.
  • Hydration state: Dehydration as well as an overload of fluids, resulting in hypoxia can cause delirium.
  • Infectious foci: Careful examination to rule out conditions such as meningitis, encephalitis, pulmonary consolidation etc.
  • Evidence of intoxication or withdrawal for alcohol, and recreational drugs are an important part of delirium work up. Look for tremors, pupil size, needle tracks etc.

Systemic Examination


  1. Bhat R, Rockwood K (November 2007). "Delirium as a disorder of consciousness". J Neurol Neurosurg Psychiatry. 78 (11): 1167–70. doi:10.1136/jnnp.2007.115998. PMC 2117593. PMID 17488786.
  2. Lees, Rosalind; Corbet, Sinead; Johnston, Christina; Moffitt, Emma; Shaw, Grahame; Quinn, Terence J. (2013). "Test Accuracy of Short Screening Tests for Diagnosis of Delirium or Cognitive Impairment in an Acute Stroke Unit Setting". Stroke. 44 (11): 3078–3083. doi:10.1161/STROKEAHA.113.001724. ISSN 0039-2499.
  3. Tieges Z, Maclullich AMJ, Anand A, Brookes C, Cassarino M, O'connor M; et al. (2021). "Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis". Age Ageing. 50 (3): 733–743. doi:10.1093/ageing/afaa224. PMC 8099016 Check |pmc= value (help). PMID 33951145 Check |pmid= value (help).

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