Confusion (acute and chronic)

Hypoglycaemia, coagulopathy, encephalopathy → fulminant hepatic failure; maternal and fetal emergency

Delirium tremens and withdrawal seizures are medical emergencies; suspected Wernicke’s → immediate parenteral thiamine

Decompensation (ascites/SBP, variceal bleed, encephalopathy) → admit/treat

Severe (>3.5 mmol/L) or symptomatic (confusion, dehydration, arrhythmia) → emergency IV fluids + bisphosphonate

Severe neuroglycopenia (seizures, coma)

NEUROLEPTIC SENSITIVITY — antipsychotics can cause severe rigidity/irreversible deterioration; recurrent falls

Generalised peritonitis + sepsis → emergency

Septic shock/Reynolds pentad → emergency resuscitation + urgent biliary decompression

Severe alcoholic hepatitis (Maddrey discriminant function ≥32) → consider corticosteroids; high mortality

Severe hypercalcaemia (≥3.5 / symptomatic) → IV fluids + treat the cause; hypercalcaemia of malignancy → IV fluids then

Reduced consciousness, neurological signs, cardiac ischaemia, pregnancy → consider hyperbaric oxygen

Compartment syndrome → EMERGENCY fasciotomy; diagnosis is clinical (pain out of proportion + on passive stretch) — do NO

Reduced GCS, status epilepticus, raised ICP; delay in aciclovir worsens outcome

Status epilepticus (≥5 min); first seizure needs assessment; pregnancy/teratogenicity; SUDEP risk

Severe (>3.5) / symptomatic hypercalcaemia → emergency IV fluids + bisphosphonate

Profound dehydration/hypovolaemic shock, reduced GCS, very high osmolality; high thrombosis risk

Reduced consciousness/seizure; sulfonylurea-induced hypoglycaemia is prolonged → admit/observe

Hypercalcaemia, acute kidney injury, or metastatic spinal cord compression → emergencies

CURB-65 high (3–5) / sepsis → hospital/ICU assessment; respiratory failure → oxygen/ventilatory support

ALL cases are emergencies — risk of suicide and infanticide; admit, ideally to a Mother and Baby Unit

Severe hypercalcaemia (>3.5) or hypercalcaemic crisis (confusion, dehydration, arrhythmia) → emergency (IV fluids ± bisp

Exhaustion, rising CO2 with acidosis, or peri-arrest → urgent ventilatory support (NIV/intubation) and critical care

Lactate >2, systolic BP <90 / MAP <65, reduced GCS, mottling, anuria → escalate to critical care

Acute severe symptomatic hyponatraemia (seizures, reduced GCS) → hypertonic saline in a controlled setting

Reduced/fluctuating GCS, anticoagulation, large collection with midline shift

Severe/rapid hyponatraemia with seizures/coma → hypertonic saline (specialist; avoid overcorrection → osmotic demyelinat

Wernicke is a medical emergency — untreated it becomes irreversible Korsakoff; giving glucose before thiamine can precip

Encephalopathy/cerebral oedema, hypoglycaemia, rising INR/lactate → transplant centre (King's College criteria)

Rapid decline, focal signs, early gait/falls, fluctuation or early hallucinations → reconsider the dementia subtype or a

Hypoactive delirium is easily missed; a new acute confusion is delirium until proven otherwise — find the cause