Haematological changes and state of hydration during delirium tremens and related clinical states

In order to obtain some information about the state of hydration and possible haematological changes in patients with delirium tremens (grade 3) and related clinical states (grade 2) various clinico-chemical variables were measured at the time of admission and repeatedly until clinical recovery from the psychotic state. In grade 3 patients plasma protein concentration, blood haemoglobin concentration, blood haematocrit and erythrocyte count decreased between admission and recovery probably reflecting a slight haemodilution. The changes were all within the normal range for the variables and there was thus no indication of hypo- or hypervolemia. Delirium tremens patients without concomitant somatic diseases should not be routinely treated with intravenous fluid therapy. In grade 2 patients no statistically significant changes occurred in the above mentioned variables. In the grade 3 patients there was a dramatic (100%) increase in plasma iron concentration between admission and the subsequent morning and this was probably related to the elimination of ethanol from the body. In grade 2 patients, where the initial blood alcohol concentration was lower than in grade 3 patients, no change in plasma iron concentration occurred. A statistically significant increase in reticulocyte count between admission and recovery in both grade 3 and grade 2 patients probably reflected the recovery of haemopoietic tissue from the insult of the preceding ethanol intoxication. The same may be true for the prevailing anisocytosis, whereas the trend towards leucocytosis may be due to unspecific stress during the ethanol withdrawal reaction. The rapid changes in some of the clinico-chemical variables stress the importance of initiating investigational procedures immediately at the hour of admission.