Use of Potassium in Protracted Insulin Coma

Abstract

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.