In Reply.—
Dr Karis correctly emphasizes the difficulty in assessing efficacy of sedatives in stopping progression of alcohol withdrawal, but I disagree with his analysis in four ways. First, in the study of Kaim et al,1 he has not included the patients they stated had DTs plus seizures, making the total number with DTs seven in the phenothiazine-treated group and 12 in the placebo-treated group. Second, he has excluded the data of Kaim and Klett,2 who studied patients who had disorientation, tremor, and hallucinations, but who were able, for the most part, to take oral medications and who had no "serious medical or surgical conditions." In these patients, there was only one death of 189 patients, occurring after the first dose of pentobarbital sodium, and I judged the patient population to have ethyl alcohol withdrawal but not severe DTs as recently defined.3 Third, he has excluded the