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THE TREATMENT OF DELIRIUM TREMENS WITH INSULIN IN SUB-SHOCK DOSES
G. WILSE ROBINSON, JR.
Am J Psychiatry 1940;97:136-151.
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The Neurological Hospital, Kansas City, Mo.

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Abstract

Insulin with carbohydrates seems at this time to be the only method of treating delirium tremens which has improved upon the statistical results reported by Kraepelin, who used diet, support and paraldehyde for rest.Insulin is effective because it rapidly re-establishes normal carbohydrate metabolism. It likewise quickly replaces deficient glycogen reserves in the liver. These two factors, which are part of the same process, re-vitalize the liver and re-establish normal protein and fat metabolism. During the period of deficient carbohydrate metabolism and deficient liver function, toxic intermediate products of abnormal protein and fat metabolism have become so concentrated that they have produced the pathology and symptoms of delirium tremens. Re-establishment of the liver function advances the progress of metabolism, and these products are carried forward to their ultimate normal, less noxious end products. This reduces toxic concentrations, removes the "irritative" factor, the cerebral pathology reverses itself by natural processes, and the delirium is quickly relieved.Insulin therapy is rapid, effective and simple to administer. The series presented by Steck and by me had a combined time for complete clearing of the delirium of 2.5 days.

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