Delirium tremens: SOME CLINICAL FEATURES. PART II

Abstract

Twenty patients with delirium tremens (grade 3) and a less severe clinical state (grade 2) were thoroughly investigated from the time of admission until recovery from the acute state. A lumbar puncture was performed in the majority of the patients immediately after admission and then repeated after recovery from the acute state. The CSF was both macroscopically and microscopically normal, as was the spinal fluid pressure. The clinical course was without complications and none of the patients were severely dehydrated. All were treated with barbital, a long acting barbiturate. The duration of the acute state and the total amount of drug necessary in the treatment were equal in the 2 groups of severity. Patients with proper delirium tremens needed significantly fewer barbital doses during the 1st hours after treatment was initiated than did patients with a less severe clinical state. The opposite was seen .apprx. 12 h later. These findings are discussed in relation to the high blood alcohol concentration seen at the time of admission in the majority of the patients with proper delirium tremens, but not in patients with grade 2. Barbital evidently exerts its effect due to cross-dependence properties with alcohol. The majority of the patients had moderately elevated blood pressure, pulse rate and rectal temperature at the time of admission; these variables were to a great extent normalized within 48 h after admission. No differences in those physical signs were seen between patients with fully developed delirium tremens and patients with less severe clinical states. The patients'' condition during the acute state was followed by means of a delirium tremens rating scale. Physical symptoms were similar in various degrees of severity of the clinical condition 18-24 h after admission, the differences in mental symptoms between patients with grade 3 and patients with grade 2 had disappeared; 48 h after admission the patients'' condition was to a large extent normalized. Methodological problems in using a rating scale in conditions as delirium tremens are discussed. The results are discussed in relation to etiology and pathogenesis of delirium tremens. A qualitative, and not only a quantitative, difference apparently exists between a severe withdrawal reaction and fully developed delirium tremens, and a hypothesis about a point of no return is suggested.