Caregiver Perspective: Delirium and UTI's - What's the Connection?

Did you know that delirium was a symptom of a urinary tract infection? Neither did I, but it's something I'm learning to recognize. Apparently, I'm 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. My husband Lynn’s doctor made the connection for me very recently.

Delirium during a spell of pneumonia

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

I honestly thought his shortness of breath was behind the confusion and the CO2 level or oxygen saturation levels were all that I needed to monitor to keep him straight. Here’s what he was experiencing.

Waking up confused from naps

Each night as the sun went down, he would take a nap. When he would awaken from his nap, he would be confused. He did not know where he was or what things in the room were. He hallucinated (seeing things that were not there) and had delusions (believing events were in progress that were not actually happening). At times, he did not know me and confused me with his sister or a character on TV.

Aggressive behavior

His behavior even became aggressive. He would ask me when I was leaving for the night or argue with me about his ability to walk. He has not been able to walk in years. However, he believed that he could and determined that I would pull him onto the floor so that he would be able to walk.

Most of the time, the behavior would come and go, clearing after maybe ten or fifteen minutes of me giving him evidence of where he was. Then, it would return with the next nap. Sometimes I think it never left, but he just pretended to accept what I told him.

He returned to normal in the morning

When morning came, the behavior continued initially, but within thirty minutes of sunup, his mind was clear, and the hallucinations 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 probably triggering the delirium. It seemed to fit in with the picture of him taking a nap, having an oxygen decline with sleep apnea, trigger the delirium all night and get better in the morning.

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

Connecting the delirium to the UTI

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 very common for UTI’s to cause delirium. He assured me that as the infection left, so would the delirium. It did.

Why does a UTI cause confusion and delirium?

Interestingly, an article came out in a nursing journal about the topic a few days after that explaining that UTI’s 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 doesn't function as well. It tends to misfire. The result is a lot of chaotic short circuit messages resulting in the following:

• Hallucinations
• Delusional thoughts
• Rambling speeches
• Paranoid comments
• Forgetfulness
• Disturbed sleep patterns
• Agitation
• Odd sensory perceptions

Symptoms of urinary tract infections with MS

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, 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” wasn’t there before.