Stupor

Other Substances. Driving under the influence of alcohol cases are compHcated because people sometimes consume alcohol with other substances (11—13). The most common iUicit substances taken with alcohol are marijuana and cocaine (see Table 1) (14). In combination with alcohol, some dmgs have an additive effect. When a blood or urine alcohol sample is tested for alcohol and the result is well below the legal concentration threshold yet the test results are not consistent with the arresting officers observation that the subject was stuporous, further toxicological tests for the possible presence of dmgs are indicated. 

OtherMa.gnesium Disorders. Neuromuscular irritabHity, convulsions, muscle tremors, mental changes such as confusion, disorientation, and haHucinations, heart disease, and kidney stones have aH been attributed to magnesium deficiency. Excess Mg " can lead to intoxication exemplified by drowsiness, stupor, and eventuaHy coma. 

Acute benzene poisoning results in CNS depression and is characterized by an initial euphoria followed by staggered gait, stupor, coma, and convulsions. Exposure to approximately 4000 ppm benzene results in complete loss of consciousness. Insomnia, agitation, headache, nausea, and drowsiness may persist for weeks after exposure (126). Continued inhalation of benzene to the point of euphoria has caused irreversible encephalopathy with tremulousness, emotional lability, and diffuse cerebral atrophy (125). In deaths arising from acute exposure, respiratory tract infection, hypo- and hyperplasia of sternal bone marrow, congested kidneys, and cerebral edema have been found at autopsy. 

The threshold limit value for ethyl alcohol vapor in air has been set at 1000 ppm for an 8-h time-weighted exposure by the ACGIH (1989 listing). The minimum identifiable odor of ethyl alcohol has been reported as 350 ppm. Exposure to concentrations of 5,000—10,000 ppm result in irritation of the eyes and mucous membranes of the upper respiratory tract and, if continued for an hour or more, may result in stupor or drowsiness. Concentrations of this latter order of magnitude have an intense odor and are almost intolerable to begin with, but most people can become acclimated to the exposure after a short time. Table 7 gives the effects of exposure to even heavier concentrations. 

Narcosis Narcosis is a state of deep stupor or unconsciousness, produced by a chemical substance, such as a drug or anesthesia. Inhalation of certain chemicals can lead to narcosis. For example, diethyl ether and chloroform, two common organic solvents, were among the first examples of anesthesia known. Many other chemicals that you would not suspect can also cause narcosis. For example, even though nitrogen gas comprises 80% of the air we breathe and is considered chemically inert (unreactive) it can cause narcosis under certain conditions. Always work with adequate inhalation and avoid inhaling chemical fumes, mists, dusts etc. whenever possible. Use fume hoods and respirators as necessary. 

Narcotic gases Gases that produce sleep, stupor, or insensibility when inhaled in certain concentrations. 

Anorexia, nausea, vomiting, lethargy, bone tenderness or pain, polyuria, polydipsia, constipation, dehydration, muscle weakness and atrophy, stupor, coma, cardiac arrest... 

Ibric S, Jovanovic M, Djuric A, Parojcic J, Petrovic SD, Solomun L, Stupor B. Artificial neural networks in the modelling and optimization of aspirin extended release tablets with Eudragit LlOO as matrix substance. Pharm Sci Tech 2003 4 62-70. 

Specific predictive factors for outcome after surgical intervention have not been well defined in the literature. In one prospective, multicenter observational study of 95 patients, the state of consciousness was the only predictive factor retained in a logistic regression analysis." In this study, there was a 2.8-fold increased risk for poor outcome for each increase on a three-step scale (awake/drowsy, somnolent/ stuporous, and comatose), and good outcomes (modified Rankin Scale score <2) were achieved in 86%, 76%, and 47% of patients within each group, respectively. 

Sensorium. Patients with PCP intoxication can have a clear sensorium, or they can be disoriented, confused, stuporous, lethargic, or comatose. Signs of cerebral stimulation, such as pressured speech, verbigerations, and echolalia, may also occur. Frank psychotic symptoms, including hallucinations, delusions, and paranoid ideation, are not unusual. 

Stupor—difficult to arouse, unaware of some or all elements in the environment, or not spontaneously interactive with the examiner becomes incompletely aware and inappropriately interactive when prodded strongly can be aroused only by vigorous and repeat stimuli and as soon as the stimulus ceases, stuporous subjects lapse back into the unresponsive state... 

Signs and symptoms Headache, vomiting, stupor, hemiparesis, aphasia, visual disturbances, and seizure transient ischemic attack is a strong predictor for stroke. Behavioral and performance changes may be present in patients with asymptomatic infarction. 

STB - supertropical bleach, sternutator - vomiting compound, stupor - partial or nearly complete unconsciousness. 

Ifosfamide -alkylating agent noncell cycle specific -bone marrow suppression -hemorrhagic cystitis (need Mesna uroprotection) -nausea and vomiting—mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -CNS toxicity—lethargy, stupor, coma, seizures... 

The answers arc 488-d, 489-h. (Katzang, pp 108-112, 1020.) Atropine blocks muscarinic cholinergic transmission in the brain and in the autonomic nervous system. The result is dry mouth, thirst, dry and hot skin, tachycardia, urinary retention, ataxia, restlessness, excitement, and hallucinations, followed by stupor, delirium, respiratory depression, coma, and death. 

Signs and Symptoms Depend on the site of infection. Infection may produce osteomyelitis or arthritis pneumonia [with chills, productive cough, low blood pressure (hypotension), difficulty breathing (dyspnea), or chest pain] meningitis or cerebral abscesses (with headache, fever, vomiting, stupor, coma) or intra-abdominal infections (with biliary drainage, hepatic abscess, pancreatic abscess, peritoneal exudate). 

Signs and Symptoms Range from mild fever and headache to high fever, headache, stupor, disorientation, tremors, meningoencephalitis, convulsions, spastic paralysis, and coma. There is a high incidence of neurologic sequelae. 

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