” Sickness behaviors are innate immune defenses and part of the acute phase response, a systemic enhancement of the immune system engaged EARLY in the course of an INFECTION.“

From: Encyclopedia of Animal Behavior, 2010.

Sickness behaviour includes signs of depression, anorexia, listlessness, fatigue, malaise, sleepiness, and loss of interest in social interactions and minor cognitive problems. [and I would add to the list – inner anguish and hidden loss of mind]. These behaviours are unconscious in that they are part of an overall physical response initiated by the autonomic nervous system in response to a potentially harmful internal physical condition. It could be a virus or bacterial infection, or it could also be a metabolic problem or a gradual failure of the circulation or of breathing or of an organ.

Sickness behaviour is something we all recognize and often ignore as unimportant. We wait till we feel better or we go see a doctor if we feel worse over time. . We are more careful with children. We feel their foreheads to see if they have a fever or look to see if their throat is red. We stop doing this for adults because we assume the adult will take their own temperature or tell someone if their throat is sore. And usually this is how adults react when they are sick, unless they loose their brain function before they realize how sick they are.

And it doesn’t take that much metabolic disruption to cause serious problems to the function of mind. Fever can disrupt metabolism. So can hypothermia. And hypercapnia. And blood loss. And injury. And nutrient loss or deficiency. And dehydration….And the list goes on. Metabolism balances acids and acids properly as we breathe, eat, move, sleep and excrete waste. Normal function of mind requires normal function of metabolism to adhere to a [very] narrow chemical balance of acids and bases in the blood. If the balance of acids and bases is even a little off, the mind will also be a little off -resulting in a confused state. Respiratory acidosis and alkalosis, metabolic acidosis and alkalosis will lead to, amongst other things, a confused mind. This is well known. And the chemistry is very complex. And it depends on temperature – inside and outside the body.

The investigation of metabolism and acid base chemistry and carbon dioxide pressure in the blood is non existent in ambulatory patients or even bed ridden patients admitted into the hospital for any reason. This is an even bigger problem with even a mild case of insanity or dementia [which could always be a chronic reversible delirium ]. No one investigates for metabolic treatable causes of acid base chemistry caused by hypercapnia, heart failure, kidney failure, malnutrition, infection,or inflammation. . All acid base imbalance causes a confused state and yet we do not conduct arterial blood gases [ which need to be evaluated with knowledge of body temperature and body weight for accurate results].

The partial pressure of carbon dioxide is especially key since the brain keeps tabs on carbon dioxide not oxygen. We should follow the brain’s lead especially if we discover breathing to be too slow in a patient who cannot remember their own personal details. We need better ways to monitor invisible PCO2 levels in the blood.

No one investigates chronic acid base disorders in most sick patients I think, because few doctors even understand acid base chemistry. All doctors in all specialties, I think, are wearing ideological shades that blind them to the severity of the metal confusion as well as to all the physiological “failures” that could contribute to the [often reversible] mental confusion.

It is possible to have mental confusion and be upright or walk around or even talk [albeit with changes to voice]. The brain is made up of multiple reflexes and pathways that approximate normal-ish behaviour even when the patient’s mind is very impaired.

It is possible to remain alive with mental confusion but without much reduced quality of life.

I have seen this not only by observing and speaking with Paula [and her probable hypercapnic respiratory failure] but with other friends who suffered unseen mental confusion due to many common conditions such as – continual blood and nutrient loss due to years of heavy menstruation, blood and nutrient loss due to heavy blood loss from childbirth, heart failure, kidney failure and consequences of untreated infection and inflammation. All of these will cause metabolic dysfunction and with it, the very real possibility of * altered mental status.

• altered mental status , intoxication, poisoning,depression [severe], insanity, madness – all refer to the derangement of mind due to metabolic dysfunction from illness, injury [permanent tissue damage, blood loss] or infection, needing careful medical investigation, guided by abnormal vital signs and careful subsequent physical examination and tests.. I think that the mental status can be restored with supportive medical treatments, currently available and those that will be discovered in the future.

I