October 4, 2022

OCT 4, brief saga (organic brain poetry): metabolic delirium


"911: Uncle Phil is delirious!"

EMS arrives, puzzled; they're querious.

"Doesn't use drugs or booze,

Found attacking his shoes,

And he's threatening violence serious!"

"Phil, it's wintry outside, and you're nude.

Please get dressed; we'll get tests to conclude

Why you've gone on this rant, sir.

Yes, I see at a glance, sir,

That those poor shoeless Martians are rude."

In the ER now (Phil's wearing pants, sir),

Metabolically, what is the answer?

There's hyponatremia,


And widespread but unknown late cancer.

The author was surprised to learn that urgent hospital admissions in patients with unsuspected cancer in the late metastatic phase are commonly triggered by symptoms of delirium. Among metabolic determinants, sometimes hypercalcemia (elevated blood calcium level) is found, but the cause of delirium may remain undiscovered. Hyponatremia (a low serum sodium level ) characterizes a relatively frequent metabolic derangement, not specifically linked to cancer, that may cause confusion, and even delirium or seizures, in elderly patients eating diets low in protein and salt.

This verse belongs to a series on organic causes of neuropsychiatric symptoms, the others being frontal meningioma, hypothyroid depression, general paresis of the insane, cerebral metastases, beriberi and high-dose steroids.

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