Delirium & Acute Confusion: First Steps in an Acute State

When someone slips into an acute confused state — for instance during a hard exit from heavy drinking — panic is useless, but order is everything. Dr. Saulitis stresses: don't do everything at once and in large amounts; move step by step, watching how the body responds. "What we need right away" is to give the body its footing back: fluids, salts, vitamins and sleep. This is not a self-treatment manual but an explanation of the logic behind the first actions.

Observe first, act second

The first rule is not to rush fluids into the person. The doctor warns: after prolonged intoxication the heart may be in trouble, and a sudden fluid load is dangerous. So the order is: check for swelling, check the pulse (no tachycardia) and blood pressure. Only then comes the question of drinking.

"First we don't look at giving drink — we look at whether they urinate. First we check urination, then we give drink."

The principle of balance is simple: give about half a litre of fluid, see whether it is passing out, and only then continue. You must not "overflow" the system and overload the heart and lungs.

Restore water and salts

If the person can drink on their own, the doctor says, there's no need for IV "pumping tricks" — just give fluids by mouth. It is important to add salt: it helps the water stay inside the body. A good option, he notes, is thin rice broth with salt at a physiological level — no stock or extras, just fluid with the needed ingredients.

Vitamins as the foundation

The doctor calls vitamins a mandatory step of recovery. With prolonged alcohol use the B group gets "washed out" — and that, in his words, is the main factor giving neurons support. Hence the focus on B1, B6, B12 and magnesium, plus vitamin C. Specific doses and forms are a matter for a doctor and a guide; he does not name them on open air.

Secure sleep — switch the "bridge"

The key to leaving the acute phase is sleep. The doctor puts it vividly: once the person has slept, "the bridge has switched over," and things get easier. Among pharmacy options he mentions quetiapine — calling it one of the gentlest, one that does not create dependence and barely adds weight. His key caveats: start with the smallest dose, take it about an hour before sleep, and adjust the dose individually — "like an accordion."

"The dose is adjusted like an accordion: more if stress is high, none at all if you feel well."

At the same time he is explicit: specific medication is prescribed by a doctor for a specific person, and there is no universal "just take this."

Calm and forewarned

The doctor repeats that a spotted marker is not a reason to panic, but a signal to "calmly take measures." When we understand what is happening, we are already forewarned and act consciously rather than blindly.

Practice: a checklist of first steps

1. Observe before acting: check for swelling, pulse (no tachycardia), blood pressure.
2. First — is fluid passing through: give a little to drink, confirm the person is urinating, then continue.
3. Replenish salts and water: fluid with salt (e.g. thin rice broth), keeping balance — do not "overflow."
4. Give vitamins: B group (B1, B6, B12), magnesium, vitamin C — as the foundation of recovery.
5. Secure sleep: the main task of the first phase is to let the person sleep; specific agents and doses only through a doctor.