All of the following are metabolic causes of Delirium, except - - UPPSC 2023

UPPSC 2023

Medical & Surgical Nursing

Medium

Appeared in: UPPSC 2023

Explanation

Hypertensive encephalopathy is the correct answer as it is not a metabolic cause of delirium.
It is classified as a cerebrovascular disorder.
The underlying mechanism is severely elevated blood pressure leading to a breakdown of cerebral autoregulation and subsequent cerebral edema.
This pathophysiology is vascular in nature, distinguishing it from metabolic causes which involve derangements in the body's chemistry and toxin accumulation.

Option A: Porphyria is a group of rare metabolic disorders affecting the production of heme, which can lead to neurotoxic symptoms, including delirium.
Option B: Hepatic encephalopathy is a classic metabolic cause of delirium resulting from the accumulation of toxins (like ammonia) due to liver failure.
Option D: Uremic encephalopathy is a classic metabolic cause of delirium resulting from the accumulation of uremic toxins due to kidney failure.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Delirium as background academic context rather than a clinical decision trigger.
Recognizing the underlying cause of delirium is a critical nursing responsibility. The treatment for delirium caused by hypertensive encephalopathy (e.g., rapid but controlled blood pressure reduction) is vastly different from treating metabolic causes (e.g., dialysis for uremia, lactulose for hepatic encephalopathy).
A nurse's initial assessment, including vital signs (especially blood pressure), recent medical history (liver/kidney disease), and medication review, provides crucial clues to differentiate the etiology of a patient's acute confusion.
What if? If a patient with known chronic kidney disease becomes acutely confused, the nurse should have a high index of suspicion for uremic encephalopathy and anticipate orders for blood tests like BUN and creatinine, while also monitoring for other potential causes.

How to Approach the Question

First, identify the core subject of the question, which is 'causes of Delirium'.
Pay close attention to the keyword 'except'. This means you are looking for the option that does NOT belong to the group 'metabolic causes'.
Go through each option and classify it based on its underlying pathophysiology.
Classify Porphyria: It's a disorder of heme metabolism. So, it's metabolic.
Classify Hepatic encephalopathy: It's caused by toxin buildup from liver failure. So, it's metabolic.
Classify Hypertensive encephalopathy: It's caused by extremely high blood pressure affecting brain blood vessels. So, it's vascular.

Concept Tested & Keywords

Concept Tested: Etiology of Delirium
Stem keywords: Delirium, metabolic causes
Lead-in keywords: except
Negative lead-in flag: The question uses 'except', requiring you to find the option that does not fit the specified category (metabolic causes).

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E6 Medicine Harrison 22e Part 1 p. 225-227

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2519-2521