Coma exogenous

Hepatic coma can be subdivided according to its aetiology as follows (7.) hepatocyte disintegration coma (= endogenous coma as a result of the loss of parenchyma), (2.) liver cell failure coma (= exogenous coma as a result of metabolic disorders, almost always in the presence of cirrhosis), (3.) electrolyte coma (= so-called false coma due to dyselectrolytaemia, almost always iatrogenic), and (4.) mixed forms of coma. (s. pp 214, 276, 381) (s. tab. 15.5)... 

Before I continue, it is paramount that the reader realizes just how dangerous exogenous insulin use is. Where as years of abuse of the most toxic steroid may destroy your liver, a single mistake when using insulin can cause coma, brain damage, or death. THIS IS A FACT Use of exogenous insulin should only be considered under a qualified medical supervision. 

Portosystemic encephalopathy (PSE) develops in chronic liver diseases and/or in the wake of portosystemic circulation. Liver cirrhosis with its hepatofugal collateral circulatory pathway is thus the focus of interest in this clinical form of disease. The term PSE is identical to exogenous liver coma or liver cell failure coma . PSE can be further subdivided according to its symptomatology and depending on its form and degree of severity. There are three forms of portosystemic encephalopathy (1.) subclinical (or latent) PSE, (2.) acute or acute recurrent (episodic) PSE, and (i.) chronic recurrent or chronic persistent PSE. 

Exogenous hepatic coma has a better prognosis than endogenous hepatic coma. 

Fulminant or protracted liver failure is caused by medicaments in 10-15% of cases. A reduction in the functional liver mass to < 20-35% is deemed to be a critical stage. However, the death of the patient may already occur due to secondary metabolic disorders (so-called exogenous hepatic coma) before the extent of the parenchymal loss has fallen below the critical threshold (so-called endogenous hepatocellular disintegration coma), (s. tab. 29.10)... 

The most serious side effect of exogenous insulin administration is the development of severe hypoglycemia, such as occurred in Jim Bodie. The immediate adverse effect relates to an inadequate flow of fuel (glucose) to the metabolizing brain. When hypoglycemia is extreme, the patient may suffer a seizure and, if the hypoglycemia worsens, may lapse into a coma and die. If untreated, irreversible brain damage occurs in those who survive. 

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