Coma caused

Although the responses depicted in curves A, B, and C of Figure 2-15 approximate the shape of a simple Michaelis-Menten relation (transformed to a logarithmic plot), some clinical responses do not. Extremely steep dose-response curves (eg, curve D) may have important clinical consequences if the upper portion of the curve represents an undesirable extent of response (eg, coma caused by a sedative-hypnotic). Steep dose-response curves in patients can result from cooperative interactions of several different actions of a drug (eg, effects on brain, heart, and peripheral vessels, all contributing to lowering of blood pressure). 

A third interpretation for the mental depression in hepatic failure is suggested by McDermott s group (M5). The impression gained by the clinical observations of these investigators is that the coma caused by... 

Hull M, Kottlors M, Braune S. Prolonged coma caused by low sodium and hypo-osmolarity during treatment with citalopram. J Clin Psychopharmacol 2002 22(3) 337-8. 

Hull M, Kottlors M, Braune S. Prolonged coma caused... 

Inhalation Inhalation of high concentrations may cause central nervous system effects characterized by nausea, headache, dizziness, unconsciousness, and coma. Causes respiratory tract irritation. May cause liver and kidney damage. Aspiration may lead to pulmonary edema. Vapors may cause dizziness or suffocation. Can produce delayed pulmonary edema. Exposure to high concentrations may produce narcosis, nausea, and loss of consciousness. May cause burning sensation in the chest. 

Respiratory support with oxygen may be required for respiratory depression associated with Rohypnol ingestion. A benzodiazepine antagonist can reverse respiratory depression and coma caused by overdose but is not routinely recommended because it can precipitate withdrawal symptoms and seizures. There is no antidote to GHB overdose. Ventilator respiratory support, seizure control, and supportive care may be required. Symptoms often resolve within 3-4 h. Abuse of both rohypnol and GHB can cause withdrawal symptoms. Long-term use of Rohypnol can cause seizures, tremors, and anxiety. Long-term abuse of GHB withdrawal can last from days to weeks. GHB withdrawal includes anxiety, tremors, disorientation, hallucinations, and insomnia. 

Alcohol is a common cause of coma in all age ranges. Coma depth and length is associated with the amount of alcohol ingested, and this shows wide inter-paiiem variation. Alcoholic coma can be associated with head injuries, hypothermia and the presence of other drugs with which its action may be additive. In most cases, coma caused by ethanol will resolve relatively rapidly, the exception being when there is hepatic insufficiency. In cases where the blood alcohol level exceeds 80 mmol/l. haemodialysis may be required. The fact that alcohol can... 

Coma associated with a cerebrovascular accident will have an abnipt onset and give rise (in most ca.ses) to unilateral signs. Coma caused by metabolic or toxic causes will usually affect all parts of the body equally and will develop over a period of lime. 

Table 7-2 shows the oral doses of atropine causing undesirable responses or symptoms of overdosage. Measures to limit intestinal absorption should be initiated without delay if the poison has been taken orally (see Chapter 64). For symptomatic treatment, intravenous physostigmine rapidly abolishes the delirium and coma caused by large doses of atropine, but carries some risk of overdose in mild atropine intoxication. Since physostigmine is metabolized rapidly, the patient may again lapse into coma within 1-2 hours, and repeated doses may be needed (see Chapter 8). 

What clinical signs and symptoms help to distinguish a coma caused by an excess of blood glucose and ketone bodies due to a deficiency of insulin (diabetic ketoacidosis [DKA]) from a coma caused by a sudden lowering of blood glucose (hypoglycemic coma) induced by the inadvertent injection of excessive insulin—the current problem experienced by Di Abietes ... 

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