Excited delirium: “I’m so excited … I just can’t hide it”

Abstract

The term “Excited Delirium” is a subcategory of delirium, which describes a syndrome of altered mental status, agitation, and overactive adrenergic autonomic dysfunction, typically in the setting of acute on chronic drug abuse or serious mental illness. Hyperthermia, severe metabolic acidosis, rhabdomyolysis and hyperkalemia are also common features of Excited Delirium Syndrome. The pathophysiology of the Excited Delirium Syndrome is unclear, however it may involve dysregulation of dopaminergic pathways in the brain. Treatment involves rapid chemical restraint, treatment of hyperthermia, and treatment of metabolic derangements.