A 56-year-old man is admitted to the medical ward is treated with antibiotics for 4 days. He developed altered sensorium and could not recognise the doctor and the nurse. He believes that he is imprisoned and that there is a conspiracy to poison him. He is repoed to have seen scorpions on his bed:

The young man in the scenario is suffering from an acute confusional state or delirium. Acute confusional state is often associated with clouding of consciousness (reduced aleness, impaired attention and concentration), Disorientation (disorientation in time, place and person) and impairment in sho term memory. The condition is associated with perceptual abnormalities like visual and auditory hallucinations. The commonest medical causes are low or high blood sugar, electrolyte imbalance, alcohol related (delirium tremens) and infection. The commonest infectious causes are respiratory tract and urinary tract infections. Ref: Acute Medicine: A Practical Guide to the Management of Medical Emergencies, 2007 By David C. Sprigings, John B. Chambers, T86.1.