Coma

Background

• State of reduced alertness and responsiveness from which the pt cannot be aroused

DDX

1. Diffuse brain dysfunction
   1. Encephalopathies
      1. Hypoxic encephalopathy
      2. Metabolic encephalopathy
         1. Hypoglycemia
         2. Hyperosmolar state (e.g., hyperglycemia)
         3. Electrolyte abnormalities (hypernatremia or hyponatremia, hypercalcemia)
         4. Organ system failure
         5. Hepatic encephalopathy
         6. Uremia/renal failure
         7. Endocrine (Addison disease, hypothyroidism)
         8. Hypoxia
         9. CO2 narcosis
      3. Hypertensive encephalopathy
   2. Toxins
   3. Drug reactions (NMS)
   4. Environmental causes
      1. Hypothermia
      2. Hyperthermia
   5. Deficiency state
      1. Wernicke encephalopathy
   6. Sepsis
2. Primary CNS disease or trauma
   1. Direct CNS trauma
      1. Diffuse axonal injury
      2. Subdural/epidural hematoma
   2. Vascular disease
      1. Intraparenchymal hemorrhage
   3. SAH
   4. Infarction
      1. Hemispheric, brainstem
   5. CNS infections
   6. Neoplasms
   7. Seizures
      1. Nonconvulsive status epilepticus
      2. Postictal state

See Also

• Glasgow Coma Scale (GCS)
• GCS (Peds)
• AVPU Scale

Source

Tintinalli