A Study of Prolonged Coma Following Insulin Shock

Lester, David

doi:10.1176/ajp.95.5.1083

Cited by 15 publications

(1 citation statement)

References 4 publications

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“…In contrast to uncomplicated ICT, irreversible hypoglycemic coma is often accompanied or followed by manifestations Irreversible Coma: of disturbance of many nervous system functions, including status epilepticus, focal neurological syndromes, organic mental syndromes of the Korsakoff type, EEG changes, impaired psychological test performance, and high death rate (88,120,140,174,195,227). In most cases, the blood sugar level is normal or even elevated in the comatose state, which may last for days or weeks (3, 1 2 2 ) .…”

Section: Clinical Aspectsmentioning

confidence: 99%

Insulin shock treatment.

Hoch¹,

Pennes²

1958

Schizophrenia: A Review of the Syndrome.

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Nervous and Mental Diseases (1957) and a former Chairman of the Committee on Therapy of the American Psychiatric Association. A native of Budapest, Hungary, Dr. Hoch received his medical training at the University of Gottingen in Germany. Following an internship at the University Hospital in Gottingen, he began his psychiatric service at the Psychiatric Clinic in Zurich, Switzerland in 1928 and the following year served in the neuropsychiatric clinic of the University of Gottingen. From 1930 to 1933 he directed the outpatient department and the brain research division of that clinic. Dr. Hoch began his career in state service in 1933 at Manhattan State Hospital and became head of the then newly created shock treatment unit. Prior to his appointment as Commissioner of Mental Hygiene, Dr. Hoch was principal research scientist (psychiatry) at the New York State Psychiatric Institute. He joined the staff of the Institute in 1943 and became director of the Department of Experimental Psychiatry in 1948. Dr. Hoch has held a number of teaching posts at the College o f Physicians and Surgeons of Columbia University and at present is Professor of Clinical Psychiatry. He is Associate Editor of the American Journal of Psychiatry and Psychosomatic Medicine and has had numerous articles published in psychiatric and other professional journals. He has written and edited eleven books on psychiatric subjects.

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Section: Clinical Aspectsmentioning

confidence: 99%

Insulin shock treatment.

Hoch¹,

Pennes²

1958

Schizophrenia: A Review of the Syndrome.

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Prolonged Insulin Coma in Treatment of Schizophrenia

Rivers¹,

Rome²

1944

Arch NeurPsych

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The syndrome of prolonged coma is a phenomenon occasionally encountered during the course of insulin therapy as used in selected cases of schizophrenia. It is a complication which becomes obvious when the induced hypoglycemia is terminated by the administration of dextrose in quantities sufficient to bring about hyperglycemia. The picture differs from that of the usual uncomplicated recovery which follows the hypoglycemic state in that its criteria are:(1) normal blood sugar or induced hyperglycemia; (2) a shifting neurologic picture; (3) peripheral manifestation of fluctuant control of the autonomic nervous system, such as alterations in regulation of heat, disturbances in cardioregulatory function, sudomotor hyperactivity and hyperpnea, with consequent tetany; (4) convulsive phenomena or their equivalents; (5) prolonged coma, and (6) associated with recovery of consciousness, disturbances in the sensorium, alterations in memory function and a quantitative reduction in all higher cortical functions. The last-mentioned psychopathologic residua reflect the widespread cytologic changes which are demonstrable histologically in the brain tissue.We have correlated certain observations in an attempt to explain the occurrence of prolonged coma on a physicochemical basis.We suggest a mechanism for insulin shock which is based on the assumption that the demonstrable histopathologic and physiologic changes which accompany hypoglycemia induced by large doses of insulin may be explained on a basis of physical, biochemical and colloidal changes. We believe that, as a result of certain physicochemical processes, there is progressive cellular hydration. We conceive this process to be a reversible one, dependent on certain vari¬ ables and accomplished by the restoration of the normal dextrose substrate. However, if this point of simple reversibility is passed, additional agents must be employed to restore the cellular balance, and in cases in which the progressive hydratien has been excessive all efforts at resto¬ ration of normal cellular function fail and death of the cell follows. The location, the size and the From the Markle Unit of the Pennsylvania Hospital. phase of the lesion, we believe, determine the variable and shifting neurologic picture, as well as the morbidity and the mortality rate.CLINICAL CONSIDERATIONS < In this presentation of 51 periods of prolonged coma occurring in 38 patients, it must be emphasized that all patients received a solution of dextrose intravenously in sufficient amounts to raise the blood sugar to a normal level or above ; with the majority of the patients this was con¬ firmed by determination of the level of the * blood sugar. If the patient failed to respond, pro¬ vided his blood sugar was normal or above, and a sufficient period of time (fifteen to twenty minutes) had been allowed for the cellular utili¬ zation of the dextrose, the condition was judged to be prolonged coma. Excellent clinical descriptions of this complication have been given Goldman,5 in a series of 108 patients, reported...

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Use of Potassium in Protracted Insulin Coma

Stark¹

1949

Arch NeurPsych

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THE PROBLEM of protracted coma is one which faces most institutions that undertake to treat psychotic patients with insulin. According to Lester,1 it occurs once in every 1,887 normal comas. Its seriousness appears fairly obvious when thorough studies and proper clinical evaluation of the patient are undertaken and the resultant mortality and complications reviewed. Therapy of protracted coma, however, has been indefinite and controversial. The approaches in handling the problem have been manifold. The purpose of this paper is to add further to the reported cases of protracted coma and to present a relatively new mode of therapy with a possible explanation for its use. It is our aim to present the course of 2 patients in protracted coma and to indicate fully our mode of therapy for each and then to present an outline of therapy for patients in such clinical states.The state of protracted coma occurring during insulin therapy is characterized by several dominant features, all of which vary from patient to patient : ( 1 ) a normal blood sugar level and/or hypoglycemia; (2) a state of dehydration and disturbed electrolyte balance;(3) a disturbance in the sympathetic and the parasympathetic function and balance; (4) a neurologic syndrome which varies in accordance with the different stages described by Himwich 2 during the course of hypoglycémie coma; (5) a failure to respond to the routine methods of therapy for hypoglycémie coma, and (6) a recovery phase charac¬ terized by the presence of an organic syndrome, a Korsakoff-like psy¬ chosis of varied duration.

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A Study of Prolonged Coma Following Insulin Shock

Cited by 15 publications

References 4 publications

Insulin shock treatment.

Insulin shock treatment.

Prolonged Insulin Coma in Treatment of Schizophrenia

Use of Potassium in Protracted Insulin Coma

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