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THE PHYSIOLOGICAL BASIS OF THE TREATMENT OF DELIRIUM TREMENS
HENRY KRYSTAL
Am J Psychiatry 1959;116:137-147.
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Assistant Clinical Director, Detroit Receiving Hospital Department of Psychiatry; Instructuor, Wayne State University College of Medicine; and Consultant. Committee on Alcoholism, City of Highland Park Board of Health.

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Abstract

The current study involved the analysis of 700 cases of D. T., including a review of the causes of death of the 17 patients who succumbed to this illness. Forty-five patients were subjected to a study of their water and electrolyte disturbance.Delirium tremens was found to be a combination of a physiological disturbance and an emotional stress in an individual whose relation to reality is, at best, tenuous. The particular mental event precipitating delirium was felt to be the "pharmacothymic crisis." The physiological disturbance was found to be varied and consisting of one or more of the following syndromes: 1. Dehydration; 2. Low serum magnesium; 3. Low salt syndrome; 4. Brain swelling. The last two, as well as the lack of resistance to infection, frequently found in delirium tremens, were assumed to be due to an inability to respond to stress. Owing mainly to a chronic vitamin deficiency, the alcoholic is unable to respond with the formation of desoxycorticosteronelike, prophlogistic mineral-corticoids.Methods of clinical diagnosis of the several physiological disturbances involved in delirium tremens were discussed, and suggestions were made to revise the management of this syndrome accordingly.

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