When I was in medical school and during my medical internship, it was axiomatic that we treated patients—not laboratory values. That axiom remains valid in today’s high-tech medicine.
I find that sometimes my non-psychiatric colleagues fail to appreciate the gravity of alcohol and sedative-hypnotic withdrawal, a syndrome that carries a high mortality risk. And sometimes a patient can come into an ER with alcohol on his breath and a high blood alcohol level (BAL) and still be in impending delirium tremens (DTs).
A woman walked into our ER. (Yes, she really walked.) She spoke coherently but was agitated. Her BAL was the highest I’ve ever seen: 455! Within an hour she had a seizure and was in florid DTs. She had no other neurological abnormalities on physical exam or scan. So with a BAL that high, she was actually in alcohol withdrawal. She must have been routinely consuming a huge quantity of alcohol, with a high level of dependence.
We treat patients—not lab values.
- Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry