Delirium and Urinary Tract Infections

Did you know that delirium is a symptom of a urinary tract infection? Neither did I, but I am learning to recognize it. I am not the only one who has experienced its impact because there was an article on the phenomenon in one of my nursing magazines last month. Lynn’s doctor made the connection for me very recently.

Lynn had delirium for about a month when he had a spell of aspiration pneumonia. I attributed the behaviors he exhibited at that time to pneumonia. I wrote about it related to sundowner’s behaviors.

Changes in O2 and CO2 Suspected Cause

I honestly thought his shortness of breath was behind the confusion. I thought that if I monitored his O2 and CO2 levels, I would know if he was heading for trouble. However, here is what I saw happening this go-round.

Confusion After Naps

Each night, as the sun went down, he would take a nap. After his nap, he acted confused when he first awakened. He did not know where he was or recognize things in the room. He experienced hallucinations (seeing things not there) and delusions (believing he was in the middle of an event that was not occurring). At times, he did not know me. He confused me with his sister or a character on TV.

Became Argumentative

His behavior even became argumentative. He asked when I was leaving for the night and argued with me about his ability to walk. He insisted he could walk, though he had not been able to walk in fifteen years. Nothing I said could convince him that he was not able to walk. He insisted that I help him get out of bed to walk and became terribly angry when I refused.

Eighty percent of the time, the behavior came and went quickly, clearing after ten or fifteen minutes. Usually, all I had to do was give him evidence to clarify his misunderstanding, and he came around. Unfortunately, it returned with the next nap. Sometimes, I think it never left, and he pretended to accept what I told him.   

Sleep Deprivation Contributing Factor

When morning came, the behavior continued initially, but within thirty minutes of sunup, his mind was clear, and the hallucinations were gone. He has terrible sleep apnea, which contributed to our assumption of oxygen deprivation. If our theory of low oxygen or high CO2 levels was accurate, then the imbalance was triggering delirium. It seemed to fit in with the picture of him taking a nap, having an oxygen decline with sleep apnea, triggering delirium all night, and getting better in the morning. 

So, we went with that theory until this past month when it happened again but no pneumonia.

Neurologist Figured It Out

When I called his neurologist, we compared the two events. I realized that he also had a UTI when he had pneumonia. The neurologist explained that it was quite common for UTIs to cause delirium. He assured me that as the infection left, so would the delirium. It did.

UTI Causes Electrolyte Imbalance

Interestingly, an article came out in a nursing journal about the topic a week after that explanation. According to the article, UTIs cause an electrolyte imbalance. The bacteria in a UTI feed off the body’s supply of sodium, potassium, calcium, phosphorus, and magnesium. When the bacteria deplete electrolytes in the urine, the brain does not function as well. It tends to misfire. The result is a lot of chaotic short-circuit messages resulting in the following.

• Delusional thoughts.
• Rambling speeches.
• Paranoid comments.
• Disturbed sleep patterns.
• Odd sensory perceptions

See “Crazy” Think UTI

Urinary tract infections can occur without any symptoms in some people. In others, there may be burning with urination, an odor, changes in the color (darker) of the urine, an increase in frequency, or urgency in the need to “go.” In either case, if you suddenly see a change in mental status related to the symptoms above, consider the possibility of a urinary tract infection. Ask for a urine test to see if bacteria are present. It might explain why you suddenly see “crazy” where “crazy” was not before.

This article originally appeared on Multiplesclerosis.Net by Health-Union, LLC and has been reposted with permission.