Systemic conditions

• infections; for example, septicaemia, pneumonia

• metabolic disturbances; for example, renal or hepatic failure, diabetes, electrolyte imbalance, remote effects of carcinoma, porphyria

• endocrine disorders; for example, thyrotoxicosis, hypothyroidism, Cushing's syndrome

• poisons; for example, alcohol or drug intoxication or withdrawal, carbon monoxide, heavy metals

• cardiac or respiratory conditions causing cerebral anoxia

• vitamin B deficiency.

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