Excited Delirium Syndrome (ExDS): defining based on a review of the literature

J Emerg Med. 2012 Nov;43(5):897-905. doi: 10.1016/j.jemermed.2011.02.017. Epub 2011 Mar 25.


Background: Patients present to police, Emergency Medical Services, and the emergency department with aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, "superhuman" strength, diaphoresis, and lack of willingness to yield to overwhelming force. A certain percentage of these individuals will go on to expire from a sudden cardiac arrest and death, despite optimal therapy. Traditionally, the forensic community would often classify these as "Excited Delirium" deaths.

Objectives: This article will review selected examples of the literature on this topic to determine if it is definable as a discrete medical entity, has a recognizable history, epidemiology, clinical presentation, pathophysiology, and treatment recommendations.

Discussion: Excited delirium syndrome is characterized by delirium, agitation, acidosis, and hyperadrenergic autonomic dysfunction, typically in the setting of acute-on-chronic drug abuse or serious mental illness or a combination of both.

Conclusions: Based upon available evidence, it is the consensus of an American College of Emergency Physicians Task Force that Excited Delirium Syndrome is a real syndrome with uncertain, likely multiple, etiologies.

Publication types

  • Review

MeSH terms

  • Antipsychotic Agents / therapeutic use
  • Delirium / diagnosis*
  • Delirium / therapy
  • Diagnosis, Differential
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Psychomotor Agitation / diagnosis*
  • Psychomotor Agitation / drug therapy
  • Syndrome


  • Antipsychotic Agents
  • Hypnotics and Sedatives