The term "coma" is borrowed from the Greek language and in literal translation means "deep sleep".
What is a coma?
Signs of coma are inhibition or severe inhibition of central nervous system function. It is certainly accompanied by loss of consciousness. A person does not respond to light, sound and other external stimuli. Violation of the regulation of the main important body functions. Coma, as a rule, is a dangerous complication of a disease, which complicates the healing process. Depending on the reasons that entail a coma, it can develop either rapidly, as in the case of a head injury, or gradually. The main signs of coma can occur for several hours or days, and with timely treatment, deterioration can be avoided.
Thus, who needs to be considered as an acute pathological condition in which complex therapy is needed in the early stages of manifestation. Therefore, the diagnosis of “coma” is made not only to a patient who does not completely respond to external factors, but also in the event of a loss of consciousness while maintaining basic reflexes.
The clinical picture of the development of coma is formed from an understanding of the algorithm for its manifestation, as well as from knowledge of diseases and various pathologies, such as diabetes mellitus, poisoning with sleeping pills and psychotropic substances, uremia, which can lead to this condition.
Varieties of coma
There are many diseases, a coma that can become a complication. The signs of coma, its etiology were studied in detail by N.K. Bogolepov, counting more than 30 types of this condition. Only a small part of the scientist singled out as an independent disease, while the rest became syndromes and complications. It is worth noting that not the same disease in different people can cause a coma. The essence of the problem is a violation of biochemical homeostasis, hemodynamics and other problems associated with the normal functioning of the brain. The systematization of coma led to the formation of the following subsections.
Neurological coma
They are directly related to damage to the central nervous system. These include:
- coma arising from strokes;
- apoplectiform coma;
- epileptic coma;
- coma caused by trauma, for example, craniocerebral;
- coma due to the occurrence of inflammatory processes, as well as benign and malignant neoplasms in the brain and its membranes.
Coma for endocrine disorders
What caused this coma? Signs of coma are manifested in the form of a malfunction in the metabolic processes of the body due to insufficient or excessive production of hormones. If they are synthesized a little, then a coma happens
- diabetic
- hypocorticoid;
- hypothyroid;
- hypopituitary.
If the body produces a lot of hormones or the dosage of hormonal drugs is incorrectly prescribed, then thyrotoxic and hypoglycemic coma may develop.
If the water-electrolyte balance of the body is disturbed
If the human body experiences dehydration, a lack of macro- and micronutrients, salts and substances necessary to compensate for energy losses, then it can also fall into a coma. In this situation, there are two main types:
- chlorohydropenic coma, which happens if the patient does not stop intensive vomiting for a long time, for example, as in the case of pyloric stenosis;
- an alimentary-dystrophic coma, in other words, a coma from hunger.
Disturbed gas exchange causing a coma
Signs of this type are the lack of incoming oxygen, the problems of the respiratory system. These include:
- hypoxic coma, caused by a lack of oxygen coming from outside (it occurs in case of suffocation, hypobaric hypoxemia, as well as in anemia, when the blood is not saturated with oxygen, and with various circulatory disorders);
- respiratory coma, which, in turn, is divided into respiratory-cerebral and respiratory-acidotic.
Respiratory failure caused by oxygen starvation, hypercapnia, global disturbance of gas exchange processes in the lungs are common signs of coma of this subspecies.
Coma due to intoxication
It stands out as a separate group, since it is provoked by endogenous intoxications that accompany toxic infections, a variety of infectious ailments, pancreatitis, renal and hepatic insufficiency, or the effects on the body of chemical poisons: organic phosphorus compounds, alcohol, and drugs belonging to the barbiturates group, and other medicines.
In addition to this rigid classification, there are coma of unknown or mixed etiology, for which it is impossible to identify one clear reason, for example, in the case of thermal coma, caused by overheating of the entire human body. Although some sources attribute it to the neurological group.
Below, we consider individual types of coma that are more common than the rest.
Diabetic coma: classification
Diabetic coma, the signs of which will be discussed later, is caused by a shortage of insulin in patients with diabetes mellitus, which can manifest itself in three versions: hyperketonemic, hyperosmolar, hyperlactacidemic. Sometimes it is called a “cerebral coma”, because during its course, cerebral edema is observed due to the fact that with a decrease in insulin levels, the osmolarity of brain and blood cells varies unequally.
When blood sugar levels rise dramatically, a hyperglycemic coma occurs. It is most dangerous for children and the elderly. It develops gradually, as a rule, over several days.
Signs of hyperglycemic coma:
- breath with the smell of acetone;
- pallor and dry skin;
- loss of appetite;
- narrowing of the pupils;
- pain in the abdomen;
- tachycardia;
- decreased muscle tone;
- confusion of creation.
As soon as the first signs of coma begin to appear, it is urgent to call an ambulance. If you do not do this on time, the person stops responding to external factors and influences.
Hypoglycemic coma
In patients with diabetes, sugar can not only increase sharply, but also decrease. This happens due to long breaks between meals, excessive physical exertion or in the case of drinking alcohol. Hypoglycemic coma, the signs of which are described below, develops very rapidly.
Her precursors may be:
- a strong feeling of hunger;
- anxiety;
- irritable and restless state;
- low body temperature;
- shallow frequent breathing;
- increased sweating;
- nausea, migraine;
- heart palpitations;
- visual impairment;
- inhibited consciousness;
- dilated pupils ;
- muscle hypertonicity.
With the manifestation of all or part of the signs, emergency care is needed, consisting in intravenous administration, if necessary repeated, of a glucose solution and subcutaneous - adrenaline.
Coma stages
It has been established that there are a number of reasons due to which a coma develops. Signs of a coma of one or another etiology determine the severity of the process, as a result of which several stages of a coma are distinguished.
- Precoma. Here, the patient is characterized by several rather conflicting signs. On the one hand, there is blurred consciousness, disruptions in spatial orientation, slowness, and on the other, increased excitability, impaired coordination, but the main reflexes remain intact.
- Coma of the first degree. This is when the patient practically does not make contact, does not respond to external stimuli, very weakly feels even severe pain, muscle hypertonicity and insensitivity of skin receptors are observed. Pupils in this case react to light, but can diverge in different directions, as with strabismus.
- Coma of the second degree is due to a complete lack of contact, it is almost impossible to cause a painful reaction: a person can open his eyes to the maximum. Arbitrary emptying of the intestines and bladder, erratic movement of arms and legs, sharp tension and muscle relaxation are observed. Pupils hardly react to light.
- Coma of the third degree. Consciousness, reaction to light and pain are completely disabled, pressure, reflexes and temperature are reduced, breathing is slow, rare, and shallow. Man "walks by himself."
- Coma of the fourth degree. There is a complete absence of reaction, reflexes, tone, very low body temperature and pressure, breathing may periodically disappear.
A coma can occur in seconds, minutes or days. Naturally, the slower it develops, the more likely it is to return the patient to normal. That is why it is very important not to delay hospitalization if the first signs of a coma are discovered in yourself or your loved one.
Whether the prognosis is favorable depends on the severity of the coma, as well as on how quickly its primary manifestations were recognized and started to eliminate them. Coma, accompanied by damage to the brain, with liver failure has poor prognosis. It is possible to hope for a favorable outcome in case of diabetic, alcoholic and hypoglycemic coma, however, only if adequate timely therapy has been carried out.
If we are talking about an epileptic coma, then here treatment is not necessary at all. A person will come to consciousness on his own after the pathogenic factors cease to affect him.
It should be remembered that even a stay in a coma for only a few days does not pass without a trace and can negatively affect the physical and mental state.