The Differentiation of Delirium Tremens from Impending Hepatic Coma

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Abstract
The problem of differentiating impending hepatic coma from delirium tremens is one which arises less commonly in Great Britain than in the United States. It is a problem which occurs, of course, chiefly in connection with alcoholic patients and while alcoholism has declined in Great Britain it is becoming an increasing medical and social problem in certain sections of the United States (1). Thus, at the Boston City Hospital alcoholism was a factor in over 45 per cent. of patients with cirrhosis of the liver at post-mortem (2). At the Hammersmith Hospital in London alcoholism was an aetiological factor in 5 per cent. of patients with the clinical diagnosis of cirrhosis (3). There is no doubt that the problem of differentiating impending hepatic coma from delirium tremens is a common and relatively easy one in Boston, whereas in London it is a rare and therefore more difficult one.