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Diazepam and Paraldehyde for Treatment of Severe Delirium Tremens: A Controlled Trial

W. LEIGH THOMPSON, M.D.; ALLEN D. JOHNSON, M.D.; and WILLIS L. MADDREY, M.D., F.A.C.P.
[+] Article and Author Information

A preliminary abstract of this paper appeared in Clinical Research 19:357, 1971.

▸Reprint requests should be addressed to W. Leigh Thompson, M.D., Department of Medicine, University Hospitals, Cleveland, OH 44106.


OSLER MEDICAL HOUSESTAFF, Baltimore, Maryland


Ann Intern Med. 1975;82(2):175-180. doi:10.7326/0003-4819-82-2-175
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Thirty-four patients with severe delirium tremens were allocated randomly to treatment with paraldehyde (10 ml rectally every 30 minutes) or diazepam (10 mg then 5 mg intravenously every 5 minutes) until they were calm but awake. Diazepam-treated patients became calm in one half the time needed to calm patients with paraldehyde. Half of the patients had delirium tremens in association with pneumonia, pancreatitis, or alcoholic hepatitis; these patients required twice as much paraldehyde or diazepam for initial calming as patients with delirium tremens alone. Maintenance of a calm state was accomplished easily with either diazepam, intramuscularly, or paraldehyde, rectally. Adverse reactions occurred in nine patients, all of whom had been treated with paraldehyde; these patients had greater degrees of fever, tachypnea, and tachycardia and required three times longer for initial calming than patients without adverse reactions. Diazepam given under this regimen is a safe and effective sedative for management of combative patients with severe delirium tremens.

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