B was brought to the community health clinic by her family after they noticed sudden confusion and agitation over the past three days. She became increasingly restless, had difficulty sleeping, and was speaking incoherently. She wandered aimlessly around the house and struggled to recognize her children, often mistaking them for strangers. 

B has a history of untreated diabetes and hypertension. She had been recovering from a recent bout of malaria, for which she was treated with antimalarial drugs two weeks ago. Her family reported that she had not been eating or drinking well due to weakness from her illness, and they had noticed that her urine output had decreased over the past few days.

On examination, B was febrile (39°C), dehydrated, and disoriented to time and place. Her blood pressure was elevated (170/110 mmHg), and she had a rapid pulse. Neurological examination showed no focal deficits, but she was unable to follow commands or maintain attention. There were signs of malnutrition, with sunken eyes and dry mucous membranes. Blood sugar was 320 mg/dL, indicating hyperglycaemia.

Delirium likely triggered by dehydration, hyperglycaemia, and an underlying infection, potentially secondary to malaria or a urinary tract infection.

B was immediately started on intravenous fluids to correct dehydration, insulin to manage her blood sugar, and broad-spectrum antibiotics to treat a potential underlying infection. She was monitored closely for any neurological changes and electrolyte imbalances. The family was educated on the signs of delirium and the importance of managing her chronic conditions, especially during recovery from infections.

Over the course of three days, B’s mental status gradually improved as her fluid and metabolic imbalances were corrected. She regained orientation and her agitation subsided. A follow-up plan was established to manage her diabetes and hypertension, with the support of local healthcare workers and her family.