High doses of chlormethiazole in patients with alcohol withdrawal and hepatic dysfunction can cause reversible coma and unreactive EEG changes.
May cause reversible coma and EEG changes with high-dose chlormethiazole in alcohol withdrawal and hepatic dysfunction; case report leaves causality and monitoring open.
reflexes, the alpha activity in the EEG slowed to 8 Hz and maintained the frontal distribution but attenuated for short periods in response to stimula- tion.Forty-eight hours after admission the patient was alert.The final EEG performed three weeks later as an outpatient showed normally reactive 10 Hz alpha activity in a posterior distribution.The other three patients were all receiving chlormethiazole for alcohol withdrawal states.Two had generalised seizures, and all three were treated with thiamine and diazepam, and one with phenytoin and phenobarbitone.Each of the three had biochemical evidence of hepatic dysfunction, and one had mild transient hyperammonaemia.Two became comatose and one stuporous shortly after starting high doses of chlormethiazole.The initial EEGs of all three patients showed generalised or predominantly frontal alpha or slow beta activity, which did not react to the usual alerting stimuli.In the two comatose patients the activity was in the 11-12 Hz frequency range in one (see figure) and in the 12-14 Hz range in the other.The third patient, who also received phenytoin and phenobarbitone, showed frontally pre- dominant 14-16 Hz beta activity.Withdrawal of the chlormethiazole was accompanied by a return to normal consciousness with normally reactive posterior alpha activity and beta frequencies in the EEG in each case.Fpl -F3 C3- P3 -.
No takes yet. Share an insight, caveat, or question.
Chamberlain et al. (1977) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: