Causes, treatment and consequences of alcohol coma. Brain Coma Coma Unclear Ethiology Code on the ICD 10

COMA

Code (codes) on the ICD-10:

I61 hemorrhage intracerene (hemorrhagic stroke)

I62.0 subdural hemorrhage

I63 brain infarction (thromboismic stroke)

I64 stroke unspecified (ONMK)

E14.1 ketoacidotic coma

E14.2 Hyperglycemic Coma

E15 Hypoglycemic Coma

T40.9 Narcocoma

K72 liver coma

N19 Uremic Coma

E14.3 Other coma

R-40.2 Coma is unspecified (excluded: hypoglycemic.Diabietic. Such.)

Coma (from Greek. Koma is a deep sleep) - the state of insufficiency of the CNS, characterized by a violation of its coordinating activities, the autonomous functioning of individual systems, losing at the level of a holistic body to self-regulation and maintaining homeostasis; Clinically manifests the loss of consciousness, violation of motor, sensitive and self-esteem functions, the internal number of vital.

Classification Completion depending on the etiology: primary and secondary.

Most of the reasons for the coma is associated with either the direct destruction of cerebral structures, or with cerebral ischemia, or with insufficiency of carbohydrate exchange. Coms in which the violation of the metabolism of the brain (as a result of a hemorrhagic or ischemic stroke) or its mechanical destruction is due to primary cerebral processes (crank-brain injury, stroke, tumor, meningoencephalitis) are referred to primary cerebrogenic.

Coms, developing in secondary brain damage against the background of somatic pathology, exogenous (overdose of hypoglycemic drugs, during starvation, intoxication, overheating) or endogenous intoxication (insufficiency of the function of internal organs, diseases of the endocrine system, with formations) are called secondary cerebrogenic.

Clinical picture:in the clinical picture of any coma dominated the violation of the consciousness with the loss of perception of the surrounding and the very adoption of reflexes on external stretchings and disorders of the regulation of vital functions. The following forms of change in the level of consciousness are distinguished: stunning (superficial and deep), copor, coma (moderate, deep, proceitable).

The degree of severity of consciousness violations is estimated on the Glasgow scale, according to which the patient's condition is described in three parameters: opening the eye, verbal and motor responses to external stimuli.

Stunning(13-14 points on the Glasgow scale) - drowsiness, disorientation, restriction and difficulty of speech contact, single responses to repeated questions, the execution of only simple commands.

Sopor(9-12 points on the Glasgow scale) - the complete absence of consciousness, the preservation of targeted, coordinated protective movements, opening the eye to pain and sound stimuli, episodically single responses to multiple recurrence, immobility or automated stereotypical movements, loss of control over the pelvic functions.

Coma superficial(I degrees, 7-8 points on the Glasgow scale) -pravability, chaotic non-coordinated protective movements on pain stimuli, lack of eye opening to stimuli and control over the pelvic functions, light respiratory impairment and cardiovascular activities are possible.

Coma deep (II degrees, 5-6 points on the Glasgow scale) - non-prophetics, lack of protective movements, impaired muscle tone, depression of tendon reflexes, coarse respiratory disorder, cardiovascular decompensation.

Commescency Coma (Terminal)(III degrees, 3-4 scores on the Glasgow scale)) - Athonal state, Athony, Areflexia, violated or absent breathing, depression of cardiac activity.

The oppression of the consciousness and weakening of reflexes (corneal, pupil, tendon, skin) progress until the coma deposits.

Assessment of the depth of violation of consciousness in emergency situations in an adult, without resorting to special research methods, it is possible to carry out a scale of Glasgow, where a certain score corresponds to each answer, and in newborns - on the apgar scale.

Glasgow scale.

Assessment of the state of consciousness is carried out by the total 1 calculation of points from each subgroup. 15 points correspond to the state of clear consciousness, 13-14-stunning, 9-12 - Sopor, 14-8.- Comme, 3 points of death of the brain.

Differential diagnosis

Coms are differentiated with pseudo -omatous states (insulation syndrome, psychogenic astivativity, abuliac status, inconsistent epileptic status). Below are the features of the most frequently observed comatose states.

Violation of the brain function with development during crank-brain injury may be caused:

  1. damage to the skull and secondary squeezing of the brain by bone bone. The most serious is the fracture of the base of the skull, accompanied by blood and peculiarice from the nose, pharynx, ears;
  2. brain injury, i.e. contusion damage to the brain substance at the point of impact and in the area of \u200b\u200bthe counterdard. When shocking (shaking), the brain is mixed in the skull cavity in the direction of impact. In addition to the large hemispheres, the damage receives the brain barrel, often it is precisely stem symptoms that become leading in the clinical picture of a brain coma.

In the cases listed above, it is possible epi, subdural, subarachnoid, intraventricular, parenchymal bleeding. Subarachnoid bleeding and subdural hematomas, contributing to the dislocation of the brain and its compression, the development of the brain coma, are observed.

Circulatory disorders, hypercoagulation, hypoxia, lactatacidosis and irritation of brain shells with blood and detritus are the main causes of violation of the consciousness and features of the clinical symptoms of the brain coma.

Morphologically detected by the hemorrhages and necrosis of the brain fabric, mainly in the place of direct damage. At the increase in brain swelling edema, these phenomena can become diffuses up to a complete aseptic or septic (with an open injury) melting.

Often the cranial brain coma is developing gradually (after a light gap for several hours), which is associated with an increase in intracranial hematoma. In this case, the total loss of consciousness is preceded by a somance, stupidity, sopor. The most important clinical signs of increasing intracranial pressure are headache and symptom of vomiting, which is part of the total-selling syndrome.

General-friendly phenomena under cerebral coma are always accompanied by meningeal and focal symptoms. At CMT, cranial nerves are affected, developing into varying degrees of pronounced paresis and paralysis. Disturbance of the rhythm of breathing and pulse can be a sign of damage to the trunk. The dislocation of the brain is accompanied by an aisocorium, hyperthermia, bradycardia.

The diagnosis of CMT is based on history, m-echographs of the skull (deviation of echoes by more than 2 mm from the axis), computer or nuclear magnetic tomography. Diagnostic spinal puncture should be carried out with great care. EEG and angiography complement the main methods of examination.

Principles of cerebral ceremony treatment at CMT:

  • providing the vital functions since the transportation of the patient is transferred to the position lying on the side or on the back, be sure to turn his head of the lobby (in order to prevent the aspiration of the vomit mass or blood and the liquor at the fracture of the skull base);
  • oxygen therapy when saving spontaneous ventilation or during IVL;
  • restoration of the BCC and microcirculation in vessels using plasma substitutes (albumin, refooliglukin);
  • nearegetative blockade;
  • the antibiotics of a wide range of action (in some cases, dexacons - as a means of warning swelling edema);
  • neurosurgical intervention is carried out in case of verifying the hematoma, depressed or convocated fractures of the bones of the skull.

Brain Coma due to inflammation

The primary inflammation of the brain in children may be in the form of meningitis (inflammation of the soft shell), encephalitis (parenchymal inflammation), meningoencephalitis, as well as meningoencephalomyelitis.

The causes of inflammatory brain coma is a variety of. Their causative agents can be bacteria, viruses, mushrooms, rickettsia. Among the bacterial group, the most often in children are observed meningococcal, pneumococcal, stafilo and streptococcal, and tuberculous meningitis or meningoencephalitis, meningitis caused by hemophilic wand. Enterovirus and vapor etiology of serous meningitis dominates recently among viral meningitis.

Meningitis causative agents penetrate the brain tissue mainly hematogenically, but peripheral penetration is also possible. As a rule, the inflammatory process develops rapidly, the clinical manifestations of meningitis are more likely to become maximum to 3-4-pm (except tuberculosis).

The main pathogenetic factors caused by the symptoms of the brain coma are swelling of the brain, hypoxia, toxic-hypoxic cell damage. In the place of inflammation, dystrophic and necrotic changes are observed. Common and meningeal symptoms arise on the background of a feverish reaction, external manifestations of a particular infectious disease. With encephalitis (meningoencephalite), a pronounced violation of the consciousness and the emergence of focal symptoms are also observed. More often the cranial nerves are affected.

When diagnosing a brain coma accompanied by brain damage, the entire spectrum of ordinary studies is used, including compulsory cognition puncture with microscopy, biochemical research and sowing of the liquor.

The brain coma of this etiology is treated as follows:

  • aimicious antibacterial and antiviral therapy, the choice of which is determined by the diagnosis of the disease. Underground and intravenous methods of administration of drugs are usually used. The dose of antibiotics determines their ability to penetrate the hematorencephalic barrier in the context of pathology. In this regard, penicillins, for example, introduced in high doses;
  • fighting of the brain (diuretics, plasma substitutes, GKS) and its hypoxia (oxygen therapy, IVL);
  • disintellation (fluids infusion in a volume of 20-50 ml / kg per day);
  • symptomatic therapy (anticonvulsants in the presence of cramps, a neurovegetative blockade when exciting, antipyretic therapy, etc.).

If a person abuses alcoholic beverages, taking large doses of ethyl alcohol, then heavier intoxication of its body comes. Its consequence can be the development of coma - pathological condition, in which the inhibition of the central nervous system occurs, leading to the loss of patient of consciousness and to the absence of a reaction to external and internal stimuli.

The reasons

Ethyl alcohol into the blood of the toxic dose of ethyl alcohol is the main reason for the development of a person life-threatening. Even a small amount of drunk vodka or brandy, even a small amount of drilled vodka or brandy, adversely affect the body of some people, when the ethanol content in the red liquid reaches 0.2 ‰ (ppm). An alcoholic coma having a Code of ICD 10 (international classification of diseases) Code T51 is developing at a concentration of alcohol in the blood from 0.3 to 7.0 ppm, and more than 7.0-7.5 ‰ occurs.

The following factors affect the occurrence of a pathological condition:

  1. Drink fortress (the more degrees in it, the more toxic).
  2. Human weight (thin people get drunk faster than full).
  3. Age (teens and elderly people are heavier perceived alcohol).
  4. The use of alcohol empty stomach, without a snack (in the absence of food in the stomach, intoxication occurs faster).

In some cases, Koma can develop in people who drank some vodka and inxicane (this is characteristic of those who are not used to drinking strong drinks, chronic alcoholics and those who have individual intolerance of alcohol).

Ethanol on the brain

Ethanol has the ability to quickly absorb the intestines (95%) and in blood (5%). Its small amount, falling into a red liquid, dilutes it, accelerating the movement of red blood cells. With an increase in the dose, the return process takes place: dehydration and thickening of the fluid due to the fact that ethyl alcohol dissolves the erythrocyte membranes and they glue with each other, forming a bunch.

The surchargeable blood body is clogged by the brain capillaries and cause oxygen starvation of its fabrics (hypoxia). This is manifested by excitation, cheerfulness, euphoria in a drinker. Then ethanol has a neurotoxic effect on the heart of the brain, which leads to violations in the work of the bark of large hemispheres.

The increased amount of alcohol in nerve cells (neurons) destroys the relationship between them and changes their structure. When these changes affect the oblong brain, there is a sharp decrease in blood pressure and a person loses consciousness, falling into someone.

Hypovolemia

Hypovolemia is called a decrease in the volume of circulating blood. It develops due to the fact that ethyl alcohol causes the edema of brain tissues and the distribution of the fluid is disturbed. This manifests itself in humans, a decrease in blood pressure and temperature, convulsions. Hypovolemia can cause loss of consciousness.

Hypoglycemia

Hypoglycemia is a drop in glucose level. Ethyl alcohol in the body split the liver enzymes, but with a large number of alcohol they do not cope, therefore the level of carbohydrate glycogen decreases, which leads to a sharp drop in blood sugar. Because of the energy starvation, the overvoltage of the nervous system occurs, which causes the loss of consciousness and the hypoglycemic to whom. Low air temperature speeds up the development of the pathological condition, because if a person drinks in the cold (on the street in winter), then for thermoregulation it needs even more glucose.

Stages

There are 3 stages of comatose state:

  1. Surface 1 degree or resorption.
  2. Surface 2 degrees.
  3. Deep.

Each pathology phase differs from other characteristics peculiar to it.

Surface 1 degree

Initially, severe intoxication manifests itself from the impaired cutting or convulsions of the muscles, an increase in blood pressure and the strengthening of heartbreaks occurs. A man is sick or he has a lot of saliva from his mouth. Although the patient is still in consciousness, he no longer controls his actions. His breathing becomes hoarse, facial expressions and coordination of movements are broken, involuntary urination can occur.

The face acquires a crimridge shade, pupils are narrowed, but we also react weakly to bright light. If a person in this state gives a sniffing alcohol, then the reaction to the medicine will be positive. Resorption lasts from 4 to 6-7 hours. In this state, the concentration of alcohol in the blood does not exceed 4 ppm, and thanks to the sick, the patient comes to itself.

Surface 2 degrees

The duration of this phase is from 10 to 12 hours. It differs from resorption to reducing the excitation. All "freezes" in the victim:

  1. Breath declines.
  2. Muscles relax.
  3. The rapid pulse barely is trying.
  4. Breathing slows down.
  5. Pupils cease to respond to light.

With surface coma 2 degrees, a person can still feel strong pain (if he fell and hit the land), but it does not produce defecation and the deurination. If the victim loses consciousness, then the ammonia alcohol does not help him. The concentration of ethanol in the blood at this stage reaches 6-6.5 ppm.

Deep

With deep alcoholic pathology, the condition of a person worsens even more. It sweats greatly, although the body temperature goes to + 35 ° C. Blood pressure decreases, the pulse is weakening and almost does not fit. The reaction to light and pain is absent. There is a violation of the respiratory system, and the victim cannot deeply breathe. Due to oxygen starvation, the face shines, and then whites.

This condition can last up to 24 hours. If you do not have a sick help, it dies, since it is already contained 7 or more alcohol pp. The high concentration of ethanol leads to the development of cardiac and renal failure, the person has a stop of breathing, or it is chosen by the lots of the masses, suffered by a spanging language.

Symptoms

The main signs of intoxication from the victim are: abundant salivation, problems with speech and breathing (wheezing, shortness of breath, the inability to say something), the formation of the skin of the face, the absence or a weak response to pain, convulsions, loss of consciousness. If there were sober people next to the victims, noticing the above-described signs, they should provide him with first aid and call a doctor.

Diagnostics

In the diagnosis of the doctor, pay attention to the external symptoms of the coma and determine the neurological status of the victim (convulsions, reflexes, the reaction of pupils into light, consciousness and sensitivity to pain). Alcoholic pathological condition should be distinguished from other types of coma:

  1. Neurological, occurring in injuries of the head and violation of cerebral circulation.
  2. Somatic arising from diabetes and hepatitis.
  3. Toxic, coming due to taking alcoholic beverages with drugs or drugs.

For differentiated diagnostics use instrumental methods for the study of organs and tissues: radiography, CT, ultrasound. An echoorecephaloscopy is prescribed to identify the pathological process in the brain.

Large importance in diagnosis is played by urine tests and blood to the level of amylase and glucose. To determine the depth of the lesion, the analysis is prescribed on the amount of alcohol in the red liquid.

First aid

Urgent trial assistance to the patient should be rendered as soon as possible. It lies in the following actions:

  1. Add a victim to the warm premises, located on the street, and hide it with a blanket or upper clothes.
  2. Put the patient on the stomach and turn his head to the side, so that she drove down a little down. Such a pose will reduce the risk of choking and choking by the lot.
  3. Clean the nose and mouth of a person from mucus and food residues.
  4. Attach cold compress to the head.
  5. Lower the injured fabric or cotton wool moistened to the nose, moistened with ammonic alcohol.
  6. If the patient woke up, give it a drink warm, sweet water or weakly brewed tea with sugar to increase blood glucose levels.

If a person fails to lead to a sense, it is necessary to make it an artificial respiration or an indirect heart massage. All other actions can only be performed by a ambulance doctor.

Treatment

Treatment of deep and surface coma 2 degree is carried out after the patient's hospitalization and diagnosis. Intensive therapy is prescribed to restore the work of various systems of the body.

With surface

If a person has trouble with breathing, it is necessary to ensure the brightness of the bronchi, clearing them from mucus, and the supply of oxygen. Then it follows as soon as possible to prevent the absorption of ethanol into the blood and intestines, so the victim is washed with pure water with a probe.

To bring alcohol from the body, the patient put a dropper and the glucose and insulin solution intravenously, and to replenish the loss of fluid - saline.

To support the work of the heart and blood vessels, ascorbic acid and caffeine preparations are administered intravenously.

To reduce the mucus in the lungs and salivation of the colole atropine under the skin.

To restore the work of the CNS, patients prescribe a large amount of vitamins (C, RR, B1, B6).

In order to prevent the oxygen starvation of the brain, the catheterization of diuretic drugs is carried out.

With severe

With a deep coma, the patient is placed in intensive care. If the victim is unconscious, it is performed by the trachea intubation and the device of artificial ventilation of the lungs is connected. The stomach washed again. The patient shows the above-described means of intensive therapy.

Additionally, anti-shock therapy is used: plasma substitutes (REOPOLIGLUKIN, hemodez) are introduced. To prevent violations in the work of the kidneys, a bilateral lumbar blockade of Novocaine is carried out. When suspected the decay of the muscle protein (myoglobinuria), the method of hemosorption is used (abandoned blood purification from toxins). If blood pressure is strongly lowered, prednisone is introduced within a few days.

Recovery period

If the victim was assisted in a timely manner, he can leave coma in a few hours. After he has a long period of recovery, the purpose of which is to reduce the effects of the pathological condition.

During the time appointed by the doctor, the patient will need to take vitamin and mineral complexes and medicines to improve the work of the liver, kidneys, cerebral circulation. It will take more than one day to restore the water salt balance in the body. The patient will need to stick to the appointed diet, to make a special gymnastics. The entire rehabilitation period is forbidden to drink alcohol.

Effects

The consequences of the pathological state are acute renal failure and inflammation of the lungs, with a late assistance - fatal outcome.

If a person was in a deep coma from 24 hours to several weeks or months, a number of negative changes may occur in his body.

Come into consciousness, the victim can lose the ability to speak and walk. The violation of its health status will be indicated: strong headache, swelling in muscles and their subsequent atrophy, bleeding from mucous membranes, frequent pneumonia. These states will disturb the person for several years.

First Aid: Alcohol Coma

Alcoholic intoxication. Emergency care for alcohol intoxication.

Because of the lesion of the brain, the patient worsens the memory, aggression, fiscaliness or inhibition may appear. The terrible consequence is the development of dementia, identity degradation.

Diseases of this body can provoke severe condition - liver to whom. It has several stages, can be caused by various reasons and lead to severe consequences, up to death. For more information about this disease, our article will tell you.

Definition and code on the ICD-10

A regulatory document that determines the international classification of medical diagnoses of the ICD - 10 regulates the following liver diseases.

Code on the ICD - 10:

  • To 72 - not classified in other categories.
  • By 72.0 - acute and undercaping hepatic insufficiency.
  • K 72.1 - chronic liver failure.
  • 72.9 - liver failure unaccounted.

The disease develops against the background of general intoxication of the body. The body accumulate phenol, ammonia, sulfur-containing amino acids and low molecular weight fatty acids. They have a toxic effect on the brain, which is enhanced by impaired water - electrolytic balance.

Forms

Violations of the liver function may be diverse. A total of three variants of hepatic coma, which can lead to severe consequences.

What types of coma are:

  • The endogenous, in which the disorders can be caused by viral forms of hepatitis, dystrophic and destructive processes in the organ of cirrhosis, as well as the substitution of healthy liver tissue tumor or scars. It takes very painful and quickly progresses, when there is pain in the area of \u200b\u200bthe affected organ, hemorrhoidal disorders arise, jaundice and sebum itching and heavy "liver" smell of mouth. Often manifests psychosomatic violations, periods of increased activity alternate with full decline, depression and excessive fatigue.
  • Exogenous hepatic coma is more common in chronic disorders of the organ, cirrhosis and chronic renal failure. In this form of disease, there is no characteristic smell and psychosomatic signs. The disease proceeds relatively painlessly and without pronounced symptoms. It is possible to determine the problem when identifying the hypertension of the carrier veins.
  • Mixed shapes are characterized by symptoms of endogenous and exogenous forms of hepatic coma. At the same time, along with necrotic processes of body tissues, problems of the hematopoietic function are diagnosed, and the symptoms may include various manifestations of previous forms of the disease.

Stages of the disease

Depending on the severity of the patient's condition, there are three stages of this ailment. At the same time, the CNS is affected, the functions of brain activity are disturbed, there are accompanying symptoms.

The disease has the following stages:

  1. Phase precursor or ancestor. The patient is emotionally unstable, mood change is very sharp and do not depend on external influences. There may be aggression, sleep disorders (drowsiness in the afternoon, insomnia at night). It is difficult to concentrate on any question, consciousness is blurred, mental activity is slowed down. Frequent symptoms: tremor extremities, strong headache, nausea, vomiting, okota, high sweating, dizziness.
  2. Excitation phase or threatening coma. Strong emotional lift, aggressiveness, anxiety. Thinking activity is practically absent, mechanical movement and without a certain goal. It is often manifested by disorientation in time and the surrounding atmosphere. Pain sensations dull, reactions only on external stimuli.
  3. Complete or deep coma. Complete absence of consciousness, emotions and reactions to stimuli. The frequency of breathing may vary (up to a complete stop), blood circulation slows down. The level of blood pressure is reduced, the sphincter paralysis occurs, corneal reflexes are extended.

The reasons

The hepatic coma is developing against the background of already existing chronic diseases and liver pathologies, as well as with toxic effects.

The main reasons are:

  • Viral hepatitis groups A, B, C, D, E, G.
  • Viral liver diseases, including herpes, infectious mononucleosis, coxaki disease, cortex,.
  • Vasilyeva's disease - Weyl (jaundice leptospirosis).
  • Liver damage to fungal or microplasma infection.
  • Heavy intoxication toxic substances.

The threatening factors include the use of alcohol and psychotropic substances, inclusion in the diet of excessive amounts of protein food, as well as forest fungi.

Pathogenesis

The processes of pathogenesis are not fully investigated. It is known that in this state, the work of neurotiator systems is broken, and the overaffect of decay products (nitrogen compounds, fatty acids and neurotransmitters), negatively affects the work of the brain and the central nervous system.

Symptoms

Depending on the causes and severity of violations, the symptoms of the disease may differ. It is also worth considering the individual characteristics of the patient, from which the severity of the lesion and the treatment prediction also depends.

The main symptoms can be called:

  1. Feeling anxiety, frustration of thinking.
  2. Problems with bed at night, drowsiness during the day.
  3. Muscular cramps and elevated tone.
  4. Yellowing skin.
  5. Cluster of fluid in the abdominal cavity (ascites).
  6. Bleeding, hematoma appearance.
  7. Soreness in the liver area.
  8. Increase body temperature, chills and fever.
  9. Tachycardia, decrease in blood pressure.
  10. Tremor limbs, usually fingers.

In various stages, increased mental excitement, aggression and sudden mood changes may be observed. In addition, evidence of problems in the work of the liver can be a strong unpleasant smell of mouth, digestive disorders (long vomiting, constipation or diarrhea), paralysis of sphincter.

Complications

Progressive liver failure affects the overall condition of the patient, threatening his life. As such complications, this disease does not have, because the hepatic coma itself is very severe, leading to irreversible processes in the body.

Diagnostics

Determine the disease of the software.

These include bilirubinemia (increasing the concentration of bile pigment), azotemia (excess of normal indicators of nitrogenous products), reducing the level of prothrombin, cholesterol and glucose.

Urine acquires saturated yellow color, it can be detected bile acids and urobilin, feces discolored.

Urgent Care

If a sharp deterioration in health occurred outside the walls of a medical institution, the patient must be put on its side, providing a normal air flow and urgently cause an ambulance brigade.

Before the arrival of the doctors can not be changed, shake and transfer the patient. Such states require immediate hospitalization, and already in the hospital begins an active struggle for the patient's life.

What can take in the hospital:

  • Introduce a glucose solution with panangin to improve brain activity.
  • A complex of physiological solution and insulin in severe catatonic states.
  • In the first day, an increased dose of prednisolone is prescribed to remove the toxic impact on the organ.
  • Stimulation of the liver activity is carried out with the help of intravenous or intramuscular solution of nicotine acid, riboflavin, thiamine chloride and pyridoxine.

First aid is to reduce the symptoms of intoxication, stabilizing the respiratory function, water - electrolyte balance and protein metabolism. Before stabilizing the state and in order to prevent the deep coma, the patient is in the ward of intensive therapy.

Treatment

Activities on solid treatment are coordinated with the attending physician. The forecast and chances of recovery depend on many factors, including the presence of concomitant diseases, age and the degree of damage to the authority.

The following methods are commonly used:

  1. Diet and limit the number of protein consumed.
  2. Reception of antibacterial agents that reduce the activity of intestinal flora and the formation of vital products.
  3. Supporting therapy is to use the glucose solution, saline, as well as glucocorticoids.
  4. To reduce the level of ammonia, we need to receive glutamic acid and arginine.
  5. Excessive psychosomatic symptoms are adjusted by special neuroleptics.
  6. In the case of dysfunction of the respiratory system, the patient connects to an oxygen mask.

In the case of the diagnosis of toxic poisoning, all activities should be directed to the detoxification of the body. The doctor may offer blood transfusion, as well as hemodialysis, if the main symptoms also added renal failure.

How long does the hepatic coma last?

Even the most highly qualified doctor will not be able to give accurate forecasts. The patient in a state of complete coma to withdraw from it will be extremely difficult, so it is best to seek help in the early stages of the ailment.

The percentage of recovery is significantly affected by the accurate diagnosis and elimination of the cause, but more than 15% of cases cannot be determined.

Prediction and prevention

The chances of recovery in patients who have suffered a liver who is extremely low.

These are mainly no more than 20% of the survivors at the stage of the ancestors, less than 10% in the threatening phase and approximately 1% in the deep coma. Even such disappointing forecasts are not always possible, and then with timely and competent treatment.

The irreversible processes occurring in the body under the influence of decay products, as well as in oppression of functions or full failure of the organ affect the activities of the central nervous system and the brain.

To withdraw a person from the state of the deep coma is extremely difficult, and the most successful method of treatment at the moment is the transplant of donor liver and long-term drug therapy.

Preventive measures are precisely against this disease. To maintain the health of this body, it is necessary to follow the general recommendations: abandon, and admission, comply with moderation in nutrition, and also regularly expose to the body with computing physical exertion.

All problems and identified diseases must be cured in time and regularly examined if possible. The hepatic coma, regardless of the forms and stages, causes irreparable harm to health and significantly reduces the quality and lifespan, therefore it is impossible to ignore its symptoms.

  • Diaper:
    • coma with ketoacidosis (ketoacidotic) or without it
    • hyperSmolar Coma
    • hyogolcemic Coma
  • Hyperglycemic Coma BDA

1 with ketoacidosis

  • acidosis without mentioning coma
  • ketoacidosis without mentioning coma

2 † with kidney damage

  • Diabetic nephropathy (N08.3 *)
  • Intracapillary glomerulonephrosis (N08.3 *)
  • Kimmelistil-Wilson syndrome (N08.3 *)

3 † with eye lesions

4 † with neurological complications

5 With peripheral circulatory disorders

6 with other refined complications

7 with multiple complications

8 with unspecified complications

9 without complications

Included: diabetes (sugar):

  • labile
  • with the beginning of young age
  • with inclination to ketosis

Excluded:

  • diabetes:
    • newborns (P70.2)
  • glycosuria:
    • BDA (R81)
    • renal (E74.8)

Included:

  • diabetes (sugar) (without obesity) (with obesity):
    • with the beginning of adult age
    • with the beginning in adulthood
    • without a tendency to ketosis
    • stable
  • insulin-dependent sugar diabetes

Excluded:

  • diabetes:
    • distributed with power failure (E12.-)
    • in newborns (p70.2)
    • during pregnancy, during childbirth and in the postpartum period (O24.-)
  • glycosuria:
    • BDA (R81)
    • renal (E74.8)
  • violation of glucose tolerance (R73.0)
  • postoperative hypoinsulamia (E89.1)

[cm. The above-mentioned subheadings]

Included: Diabetes mellitus associated with power failure:

  • type I.
  • type II.

Excluded:

  • sugar diabetes during pregnancy, during childbirth and in the postpartum period (O24.-)
  • glycosuria:
    • BDA (R81)
    • renal (E74.8)
  • violation of glucose tolerance (R73.0)
  • sugar diabetes of newborns (p70.2)
  • postoperative hypoinsulamia (E89.1)

[cm. The above-mentioned subheadings]

Excluded:

  • diabetes:
    • distributed with power failure (E12.-)
    • neonatal (p70.2)
    • during pregnancy, during childbirth and in the postpartum period (O24.-)
    • type I (E10.-)
    • type II (E11.-)
  • glycosuria:
    • BDA (R81)
    • renal (E74.8)
  • violation of glucose tolerance (R73.0)
  • postoperative hypoinsulamia (E89.1)

[cm. The above-mentioned subheadings]

Included: Diabetes BD

Excluded:

  • diabetes:
    • distributed with power failure (E12.-)
    • newborns (P70.2)
    • during pregnancy, during childbirth and in the postpartum period (O24.-)
    • type I (E10.-)
    • type II (E11.-)
  • glycosuria:
    • BDA (R81)
    • renal (E74.8)
  • violation of glucose tolerance (R73.0)
  • postoperative hypoinsulamia (E89.1)

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, reasons for people's appeals to medical institutions of all departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

Emergency and symptoms in hypoglycemic coma

The hypoglycemic coma is the critical state of the endocrine system arising from a sharp drop in blood sugar blood. Coma develops acutely. Sometimes a short-term precursor period is so small that the coma begins almost suddenly - the loss of consciousness and even paralysis of vital centers of the oblong brain occurs within a few minutes.

Glucose in blood

Glucose is the main source of energy for the brain. The blood glucose level is an important indicator of human health. Reducing blood sugar levels, as well as its increase, launches in the body pathological processes that harm health, up to death. The normal level of glucose is the range between 3.9 and 5 mol / l.

Unlike other organs capable of receiving energy and from other sources, glucose admission is the only way of nutrition. With a sharp decrease in the concentration of sugar, the brain cells begin to starve, and as its deficiency increases, the function is broken, and the tissues are subjected to edema, partial destruction and even death.

The hypoglycemic coma (Code E-15 according to the ICD-10) refers to the life-threatening human states and is due to a sharp decrease in blood glucose level to less than 3 mm / l or its sharp drops with the subsequent development of acute starvation of the brain.

In most cases, adults and children with diabetes have been susceptible to the risk of the development of the hypoglycemic coma, receiving insulin treatment. However, in rare cases, hypoglycemic coma and in healthy people with a low-carbon diet and strong stress.

Causes of the development of the hypoglycemic coma

The main causes of the development of the hypoglycemic coma are usually associated with a violation in the application of insulin in diabetes mellitus:

  1. Introduction is too large insulin dose. A sharp and excessive decrease in glucose concentration with subsequent hypoglycemia and a coma can happen.
  2. Power Mode Disorders After Introduction Insulin. An important rule after the introduction of insulin is the timely meal of food containing carbohydrates - this prevents the reduction of blood sugar to the too low under the influence of the introduced dose.
  3. Incorrect introduction of insulin. Insulin is introduced subcutaneously, it gradually penetrates the subcutaneous fatty tissue into the blood. With incorrect introduction, its intramuscular effect of the drug is accelerated and enhanced.
  4. Incorrect calculation of the dose of insulin. With an increased physical activity or the absence of a sufficient amount of carbohydrates in food, a dose correction is necessary.
  5. The intake of alcohol during admission to the body blocks glucose, as a result of which it stops delivery to the brain. That is why the treatment of diabetes implies a complete refusal of alcohol consumption.

The above causes of the hypoglycemic coma can lead both the sudden development of this state and the gradual development of hypoglycemia.

Symptoms of status

The development of hypoglycemic coma is always preceded by certain signs.

Main clinical symptoms of hypoglycemia:

  • feeling strong hunger;
  • nausea;
  • the pallor of the skin accompanied by sweating;
  • shiver in the limbs and in the whole body;
  • change of behavior and mood: anxiety, feeling of fear, aggression;
  • disorders of the concentration of attention and coordination of movements.

The development of hypoglycemia can be lightning, possibly a sharp deterioration in the state and the development of symptoms of the hypoglycemic coma in a matter of minutes.

In the signs of the hypoglycemic coma in the initial stage, there is an increase in and strengthening all the symptoms of hypoglycemia and in the absence of assistance to the development of its finite stages:

  • loss of consciousness;
  • convulsions;
  • gradual decrease in pressure and heart rate;
  • death.

If the hyperglycemic coma came, it should be rendered immediately the first aid to any person next to the victim. To provide it with the most important task is to distinguish this condition from the hypoglycemic, in which therapeutic measures are completely opposite.

The difference between hypoglycemic coma from hyperglycemic

  1. With hyperglycemia, the skin is dry, characteristic of the appearance of cracks on the lips of the victim, whereas with hypoglycemia there is extremely abundant sweating.
  2. With hyperglycemia, shortness of breath arises, heavy breathing, compressed. In the hypoglycemic coma, breathing is more often weakened or not changed at all.

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Emergency care for coma

It is important to understand that the hypoglycemic coma always requires emergency intervention of doctors. If possible, it is advisable to call other people and ask them to raise an ambulance.

Emergency assistance in the hypoglycemic coma is to ensure the flow of glucose into the blood. If the patient is still in consciousness, it is necessary to offer him candy or water with sugar dissolved in it. If the consciousness is confused and the victim does not understand your words, it is necessary to carefully, open the patient with the mouth, with small portions try to pour sweet water under the tongue.

In the case when signs of convulsion occurred, it is necessary:

  • put a patient support, preferably on the floor;
  • under the head lay a pillow or rolled clothes;
  • if the jaws are not closed, it is advisable to put a soft object between the teeth;
  • it is possible to protect the patient from sharp and solid objects to avoid receipt of injuries in cravings.

Emergency assistance in the hypoglycemic coma requires constant monitoring of the patient before the arrival of physicians.

Upon arrival, emergency medical care begins immediately. After measuring the blood sugar level in blood, medicine is produced intravenous jet infusion of glucose and other drugs to normalize the patient's condition. After stabilization of the situation, the hospitalization of the patient is obligatory for further observation and treatment of the possible consequences of the hypoglycemic coma.

Prevention of the disease

Based on the main reasons for the development of acute hypoglycemic state, the prevention primarily includes timely treatment of diabetes mellitus, as well as observing patients with all recommendations of the attending physician and the ability to quickly cope with the symptoms of hypoglycemia.

Hypoglycemic coma in children with diabetes develops for the same reasons as in adults. Therefore, it is important to pay special attention to teaching small patients and their teachers signs of the offensive of the hypoglycemic state and the rules of combating them.

Usually doctors recommend always carrying candy with them for their use at the first signs of blood sugar decrease. Also in many countries, patients with diabetes are special cards or bracelets with the inscription "Diabetes" in order for the loss of consciousness to inform others about the possible causes of the condition.

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Hypoglycemia

Hypoglycemia: Quick description

Hypoglycemia - reduced blood glucose content of less than 3, 33 mmol / l. Hypoglycemia may occur in healthy persons in a few days of starvation or a few hours after glucose load, which leads to an increase in insulin level and reduce glucose levels in the absence of hypoglycemia symptoms. Clinically hypoglycemia is manifested by reducing glucose levels below 2, 4-3, 0 mmol / l. The key to the diagnosis - Triad Wipple: nervously - mental manifestations during starvation; blood glucose is less than 2, 78 mmol / l; Resting the attack by oral or intravenous administration of P-RA dextrose. Extremely manifestation of hypoglycemia - hypoglycemic coma.

Hypoglycemia: reasons

Risk factors

Genetic aspects

Etiology and pathogenesis

Hypoglycemia Insulinoma Automobile Hypoglycemia The artificial hypoglycemia is caused by the use of insulin or reception of oral hypoglycemic drugs (less frequently due to the reception of salicylate, b - adrenoblasts or quinine) extrapacreative tumors can cause hypoglycemia. These are usually large, located in the abdominal cavity of the tumor, most often of mesenchymal origin (for example, a fibrosarcoma), although there are liver carcinomas and other tumors. The mechanism of hypoglycemia is poorly studied; Reported intensive absorption of glucose by some tumors to form insulin-like hypoglycemia substances caused by ethanol - in persons with a significant reduction in glycogen reserves due to alcoholism, usually 12-4 hours after the binge. Mortality is more than 10%, therefore, fast diagnosis and the introduction of declarations of dextrose are needed (when the ethanol oxidation in acetaldehyde and acetate, the NADF accumulates and reduce the availability of the above-mentioned glukegenesis). The impairment of glycogenolysis and gluconeogenesis necessary for the formation of glucose in the liver during starvation leads to hypoglycemia of the liver disease lead to a deterioration in glycogenolysis and gluchegenesis sufficient for the appearance of an empty stomach hypoglycemia. Such states are observed with a lightning viral hepatitis or acute toxic lesion of the liver, but not in less severe cases of cirrhosis or hepatitis. Other causes of hypoglycemia on an empty stomach: a cortisol deficiency and / or hardware (for example, under adrenal or hypocituitarism). Renal and heart failure is sometimes accompanied by hypoglycemia, but poorly understood the causes of its occurrence.

Reactive hypoglycemia occurs a few hours after the use of carbohydrates, alimentary hypoglycemia occurs in patients after gastrectomy or other surgical intervention, leading to pathologically rapid food intake in the small intestine. Fast absorption of carbohydrates stimulates excessive secretion of insulin, causing hypoglycemia after a while after eating reactive hypoglycemia at the SD. In some cases, patients in the early stages of SD occurs later, but excessive insulin release. After receiving food, the plasma glucose concentration increases after 2 hours, but then decreases to the level of hypoglycemia (3-5 hours after meals), functional hypoglycemia is diagnosed in patients with nervously - mental disorders (for example, in chronic fatigue syndrome).

Hypoglycemia: Symptoms, Symptoms

Clinical picture

Neurological symptoms prevail with a gradual decrease in glucose level dizziness The headache confusion of the consciousness of violation of violations (for example, diplopia) of the paresthesia convulsions hypoglycemic coma (often developing suddenly).

Adrenergic symptoms dominate with an acute decrease in the level of glucose hyperhydrosis anxiety tremor limbs Tachycardia and a feeling of interruptions in the heart Increased blood adhesions of angina.

Age peculiarities

Pregnancy

Hypoglycemia: Diagnostics

Laboratory research

The effect of drugs. Sulfonylurevine stimulates the production of endogenous insulin and C - peptide, therefore, to eliminate artificial hypoglycemia, a study of blood or urine on sulfonylurea drugs will be thrown.

Special research

Differential diagnosis

Hypoglycemia: treatment methods

Treatment

Tactics of keeping

Preparations of choice

Emergency medical care If it is impossible to oral administration of glucose, 40-60 ml of 40% of RA dextrose C / B for 3-5 minutes, followed by permanent infusion 5 or 10% R - RA dextrose with neurological symptoms in children, treatment starts with infusion 10 % R-RA dextrose at a rate of 3-5 mg / kg / min or higher in hypoglycemia caused by the reception of oral hypoglycemic drugs (for example, derivatives of sulfonylurea), it is necessary to continue the infusion of dextrose and monitor patient for 24-48 hours due to the probability recurrence coma.

It is possible to introduce a patient with a / m or n / k glucagon into an upper third of the shoulder or hips (rarely used in our country). Glucagon usually eliminates the neurological manifestations of hypoglycemia for 10-25 minutes; In the absence of effect, repeated injections are not recommended. Glucagon doses: children under 5 years old - 0, 25- 0, 50 mg, children from 5 to 10 years - 0, 5-1 mg, children over 10 years old and adults - 1 mg.

Complications

MKB-10 E15 Nediabetic hypoglycemic coma E16 Other disorders of the internal secretion of pancreas P70 transient hydrogen exchange disorders, fetal and newborn T38. 3 Insulin poisoning and oral hypoglycemic [antidiabetic] preparations

Notes

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Hypoglycemia: Classification, Clinical Picture and Code of ICD-10

Hypoglycemia is the condition of the body in which the concentration of glucose in the blood is observed (compared to the norm).

Pathology is diagnosed if the level of this monosoaccharide is below 3.5 mmol per liter.

How does this pathology manifest and what is dangerous? What code has hypoglycemia on the ICD and how is it treated? We will understand in more detail.

Classification of pathology

It has hypoglycemia code on the ICD 10 - 16.0. But this pathology has several classes:

  • hypoglycemia unspecified - E2;
  • hypoglycemic Coma in the absence of diabetes mellitus - E15;
  • 4 - Gastrene synthesis disorders;
  • 8 - other violations, which in the process of studying the patient managed to clarify;
  • other forms - E1.

Under other forms of hypoglycemia, the ICD implies hyperinsulinism and encephalopathy, which develops after a coma caused by the insufficient amount of blood sugar.

Despite the fact that the classification of the ICD hypoglycemia has exactly listed codes, with the selection of medicines for its relief and therapy, doctors should also be guided by foreign reasons (class XX).

What is unspecified hypoglycemia?

Uncomfortable hypoglycemia of the ICD 10 describes as a fourth-class disease, which can be caused by metabolic disorders and / or endocrine system, as well as poor nutrition quality.

Gravity classification

There are three severity of hypoglycemia:

  • easy. With its occurrence, the patient's consciousness is not praised, and it is capable of personally correcting his own state: call an ambulance or, if this is not the first episode, adopt the necessary drugs;
  • heavy. With its occurrence, a person is conscious, but cannot independently stop manifestations of pathology due to its strong depression and / or physiological disorders;
  • hypoglycemic coma. It is characterized by loss of consciousness and its non-return for a long time. Without providing any assistance to person in such a state, serious damage can be caused - until the deadly outcome.

Causes of development

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Hypoglycemia may occur due to many factors such as exogenous (external) and endogenous (internal). Most often it develops:

  • due to improper nutrition (in particular, with regular use of large volumes of carbohydrates);
  • in women during menstruation;
  • with insufficient fluid flow;
  • in the absence of sufficient physical exertion;
  • on the background of portable infectious diseases;
  • as a result of the appearance of neoplasms;
  • as a reaction to the therapy of diabetes;
  • due to diseases of the cardiovascular system;
  • due to the weakness of the body (in newborns);
  • in mind the abuse of alcohol-containing drinks and some other types of narcotic drugs;
  • with hepatic, renal, cardiac and other types of failure;
  • with intravenous administration of a physical solution.

Listed reasons are risk factors. What exactly can serve as a catalyst for the development of hypoglycemic syndrome, is determined by the individual characteristics of the body: genetic determinism, transferred injuries, etc. Also, this state may be a consequence of a sharp change in the concentration of glucose in plasma with high to normal. Such glycemia is no less dangerous and can lead to disability or death of the patient.

A number of studies indicate that most often the pathological condition under consideration appears in people suffering from alcoholism. This is due to the fact that due to the regular admission of ethyl alcohol, the body begins to be abnormally quickly spending over. Also in the liver begins to slow down the process of glukegenesis.

Alcohol hypoglycemia may occur not only against the background of frequent abuse of alcoholic beverages, but also with a single use of large doses.

Also, doctors diagnose cases when non-normal low blood sugar is found in people who have taken small doses of alcohol. The highest risk of developing this pathology after the use of ethanol is present in children.

Symptoms

For hypoglycemia, a complex of symptoms is characterized. When sugar falling in the body, the patient most often experiences mental excitement, as a result of which it can exhibit aggressiveness and / or anxiety, anxiety and fear.

In addition, it can partially lose the ability to navigate in space and feel the headache. Vivid physiological disorders are also characteristic of this state.

The patient almost always begins abundant sweating, its skin is pale, and the limbs begin to tremble. In parallel with this, he is experiencing a strongest feeling of hunger, which, however, maybe (but not always) accompanied by nausea. The clinical picture complements the general weakness.

Less frequent manifestations of this condition: impairment of vision, violation of consciousness up to faint, from which a person can immerse themselves in whom, epileptiform attacks, noticeable behavioral disorders.

Hyogolcemic Coma

ICB code of the hypoglycemic coma - E15. This is an acute state, which, with a sharp drop of sugar in the blood, it appears extremely rapidly.

His initial manifestation is a loss of consciousness. But, unlike the ordinary fainting, the patient does not leave him after a few seconds / minutes, but remains in it at least before providing him with proper medical care.

Often the period between the first symptoms of hypoglycemia and the faint itself is very short. Neither the patient nor others do not notice the harbingers of the coma onset, and it seems to them sudden. The hypoglycemic coma is the extreme degree of this pathological condition.

Despite the fact that the clinical manifestations preceding the coma often remain unnoticed, they are present and expressed in the following: strong sweating, spasm of vessels, change of cardiac rhythm, a sense of tension, etc.

Hypoglycemic Coma is a CNS reaction to a sharp change in the direction of reducing the concentration of glycemia in the blood vessels of the brain.

With its development, at first there is a violation in neocortex, then in a cerebulic, after which the problem affects subcortical structures, and in the end, it comes to an oblong brain.

Most often, coma arises as a result of introducing incorrect insulin dosage into the body (if a patient has diabetes mellitus). If a person does not suffer from the specified pathology, it can develop and as a result of food or sulfonamide drugs.

Useful video

Most effective ways of treating and hypoglycemia prevention:

  • Eliminates the causes of pressure disorders
  • Normalizes the pressure within 10 minutes after the reception

Causes and assistance in hypoglycemic coma

Hypoglycemic comatose state - the pathology of the nervous system, which is caused by the strongest disadvantage of glucose content in the human body. Without it, most organs weaken and gradually lose their capacity. If you do not start a course of therapy in a timely manner, everything can end with a fatal outcome. Competent first aid for the hypoglycemic coma is what life will save. At the hypoglycemic coma code on the ICD 10.

Causes of state

The causes of the illness protrude:

  • inability to block this state in the development of diabetes;
  • excessive use of alcohol;
  • the exceedable course of receiving medicines;
  • stress: Inland, malnutrition, experiences, nervous breakdowns and more;
  • problems with liver and pancreas (its tumor), liver failure;
  • excess dose insulin.

The latter happens not only because of the error or ignorance. With the introduction of the substance it is important to competently calculate its combination with physical activity and carbohydrates adopted. People sometimes own false information on the rules of the procedure:

  • insulin is introduced intravenously, not intramuscularly;
  • after reception, it is necessary to take food saturated with carbohydrates;
  • unnecessary physical exertion is prohibited. They are installed by a doctor, because any unplanned activity must be accompanied by professional adjustments in the insulin dosage and the power program, receiving carbohydrates for the day.

Symptoms

Hypoglycemia is a chronic disease, pathogenesis. A person will be subject to complications without treatment. The first signs are weakly expressed, and the patient rarely draws attention to them. Among them: lethargy, fatigue and headaches, to remove which with the help of ordinary tones and painkillers does not work.

The classification of symptoms is as follows:

  • 1) Vegetative / parasympathetic / adrenergic. These include: constant nervous stress, breakdown, stress; excessive aggressiveness, anger, rage and sensation of concern, anxiety, excitement; abundant sweating; cramps, permanent trembling in the limbs; increased blood pressure; heartbeat disorder; pallor; constant feeling of nausea and hunger; Lost, drowsiness, fatigue.
  • 2) neuroglycopenic. Symptoms of this group: bad concentration, loss of attention; dizziness, glare in front of the eyes, strong headache; drowsiness, developing chronic fatigue syndrome, body lethargy; a split image; disorientation in space; hallucinations; paranoia; frequent amnesia; circulatory disorder; breathing failures, shortness of breath; breakdowns and inadequate behavior; Figheries or prior condition.

Precomptive state is calculated by clonic or tonic seizures and epileptiform fit. These signs are impossible to predict, they occur spontaneously, which puts the life of a person at risk.

In a child, these manifestations progress twice as fast as an adult. Set of symptoms identical. The lethal exodus comes more likely and surprise.

Complications

The first stage of the disease is determined by the decrease in blood sugar levels. Glucose is the main source of energy for the work of the cerebral cells. It ceases to receive substances for stable operation. After the cell, the necessary forces from spare substances are proceeded, which are not designed for such work. This self-regulation is supported by glucagon - pancreatic hormone. The body is gradually depleted, children stop developing. Due to the sharp shortage of trace elements, the brain ceases to obtain a standard oxygen dose.

If there is no urgent help in a timely manner, the disease will lead to a brain ebony and a violation of the functioning of the central nervous system (CNS). Such deviations are irreversible. An adult faces a complete change in personality and individual habits, regime, behavior, character and perception of the surrounding world. The child suffers from a sharp drop in the level of intelligence up to the maximum low threshold. Older people are in an increased risk area in the presence of coronary heart disease and heart and cardiovascular diseases. Here complications are myocardial infarction, stroke.

With frequent attacks of coma predict the occurrence of encephalopathy. This is the form of organic brain deviations that were caused by an inflammatory way. It is accompanied by a severe degree of oxygen starvation and pathology in the blood supply process. As a result, local identity degradation and rejection in the work of the CNS occurs.

The lack of insulin can also provoke an insulin shock - a clinical state characterized by a sharp loss of consciousness due to a tangible decrease in blood sugar content. The second threat is the hypoglycemic shock - a sudden strongest decrease in the glucose level, followed by a coma. Diabetic ketoacidotic coma is also provoked by a sharp insulin disadvantage.

Avoiding death in 40% of cases after the hypoglycemic coma is impossible.

Emergency assistance in hypoglycemic coma

Emergency care for the hypoglycemic coma is able to save a person life and prevent the emergence and development of pathologies caused by the state.

Signs of coma is a reaction to stress of the oblong brain. Observed:

  • absolute loss of consciousness;
  • extended pupils;
  • a sharp pale;
  • sticky cool sweat on face;
  • loose breathing;
  • elevated or standard blood pressure, heartbeat, pulse;
  • reflexes in the area of \u200b\u200belbows and knees are pronounced brighter.

The main thing is to return the person into consciousness and lead the main indicators of the body in the norm.

Different hypoglycemic to whom from any other will help the stories of events witness. Passersby easily indicate signs of defeat. Only after that you can confidently proceed to action.

The first stage of assistance in the hypoglycemic coma:

  • It is necessary to raise blood sugar levels. To do this, spend the irritation procedure: Create sharp pain through pinching or shocks on the cheeks. It will provoke the emission of catecholamines into the blood and lead a person in feeling, after it must be delivered to the nearest hospital or make an urgent call to the ambulance brigade and contact the relatives of the patient, if it is not able to do it yourself.
  • This method is acceptable and effective only at a light stage of the coma. In the opposite case, you will not be able to withdraw the victim from this state - only a doctor will help. But the introduction of glucose is still necessary: \u200b\u200bit will help to avoid serious brain lesions, CNS and violations of their functioning. Injection insulin is introduced intravenously. It will keep a person life. As a rule, patients with diabetes always have a first-aid kit, where you will find all the means for the "operation". After needing resuscitation.

Treatment

It is interesting to know that hypoglycemic and hyperglycemic (with hyperosmolar syndrome) coma are used in psychiatry as a method of shock therapy with existing deviations. For example, it slows down the progressive development of schizophrenia. Such procedures are carried out exclusively in hospital under the control of specialists with preliminary procedures for preparing patients.

In the treatment of coma, the most important thing is to make a diagnosis correctly. By ignorance, entering the injection with a solution of glucose can easily trigger the death of the patient.

Algorithm of treatment in the early stages permissible to observe at home. The mechanism is simple: it is enough to take a specific dose of fast carbohydrates. They are contained in white bread, cakes, honey, cornflakes. Drink a solution of sugar: three teaspoons mix with a glass of warm water. With a protracted attack, it is necessary to use sugar through the set periods of time (each empty) with the same dosage.

In severe cases, human defeats are sent to the clinic, where it will consist of a survey. He is prescribed inpatient treatment of the hypoglycemic coma. Inkjet intravenous administration of a forty-percent glucose solution in the amount of up to one hundred milliliters is carried out. Therapy begins with subcutaneous administration of adrenaline together with glucagon or hydrocortisone. If, after a couple of hours, the patient does not come into feelings, glucose is injected with drop 4 times a day and intramuscularly every and a half hours. To avoid dehydration, water intoxication, glucose solution is introduced in sodium chloride. With a protracted coma, mannitol is used.

The main treatment is aimed at restoring glucose metabolism. Intramusculously nurse introduces 100 ml of carboxylase and 5 ml of five percent ascorbic acid. Moisthered oxygen tones the work of the brain and heart, improves vessels.

Prevention

Any disease is much easier to prevent, rather than cure.

Principles and methods of prefigure prevention:

  • compliance with the prescribed day mode;
  • rejection of bad habits (alcohol and smoking);
  • proper nutrition;
  • compliance with the recommendations for the control of carbohydrates in the food consumed.

Diabetics should apply Sugarizing drugs, control the level of glucose. He should know the glucose index in various products, the consequences of its exceeding. There is an international table of diabetic products that are permitted to make food. It is important to know etiology: symptoms and signs of hypoglycemia, pathophysiology, ways to prevent.

If the course of treatment includes such antidiabetic medicines and tablets, such as anticoagulants, beta-adrenoblays, salicylates, tetracycline, anti-tuberculosis drugs, medicines, then control over blood sugar should be especially carefully.

It is necessary to carry out laboratory diagnostics once every 2-3 months, passing the ECG for the subject of hypoglycemia. Medical checking through the test will reveal possible deviations, will conduct a survey and say, what is your level of glucose content.

Thus, the hypoglycemic coma is a state whose symptoms are difficult to confuse with something. Treatment should be urgent, and prevention involves control of the lifestyle and therapy of the main ailment.

The information on the site is provided solely in popular-familiarization purposes, does not claim for reference and medical accuracy, is not a guide to action. Do not self-medicate. Consult your attending physician.

Hypoglycemic Coma (signs, emergency algorithm and consequences)

The consequences of diabetes are mostly delayed, the patient usually has enough time to notice the symptoms, consult a doctor, adjust therapy. The hypoglycemic to whom, unlike the rest of the complications, to prevent and on time to stop does not always manage, as it develops rapidly and quickly deprives a person the opportunity to think wisely.

In this state, the patient can only count on the help of others who do not always have information about diabetes mellitus and can be confused to whom with conventional alcoholic intoxication. To preserve health, or even life, diabetics need to learn to avoid strong sugar fall, to reduce the dose of drugs in time, when there is a high probability of provoking coma, to determine hypoglycemia according to the first signs. It will be useful to learn the rules of emergency care at a coma and familiar with them.

Hypoglycemic coma - what is it?

Hypoglycemic coma is heavy, acutely occurring condition, dangerous starvation of body cells, damage to the cortex of the brain and fatal outcome. The basis of its pathogenesis is the cessation of glucose admission to brain cells. Coma is a consequence of severe hypoglycemia, in which blood sugar indicators are reduced significantly below the critical mark - usually less than 2.6 mmol / l at a rate of 4.1.

Most often, coma occurs against the background of diabetes mellitus, especially in patients who are assigned insulin preparations. Heavy hypoglycemia and the elderly diabetics can develop, which have long adopted means that increase their own insulin synthesis. Usually, the comatose state is prevented independently or eliminated in the medical institution, if the patient was delivered in a timely manner. The hypoglycemic coma is the cause of the death of 3% of diabetics.

Maybe this condition is the consequence of other diseases in which the surplus of insulin is produced or the glucose is ceased to enter blood.

  • E0 - coma with type 1 diabetes,
  • E11.0 - 2 types,
  • E15 is a hypoglycemic coma, not associated with diabetes mellitus.

Causes provoking violation

Provocate hypoglycemic to whom a long-term usual hypoglycemia or a sharp drop of sugar. They can be caused by the following factors:

  1. Violations in the application or administration of insulin drugs:
  • increase in dose of short insulin due to improper calculations;
  • the use of a modern insulin preparation with a concentration of U100 with an outdated syringe, designed for a more diluted solution - U40;
  • after the introduction of insulin, there was no meal;
  • replacing the drug without a dose correction, if the previous one was weaker, for example, due to improper storage or expired;
  • introduction The needles of the syringe is deeper than required;
  • strengthening insulin action due to massage or warming the injection site.
  1. Reception of sugar-based drugs related to sulfanylmorate derivatives. Medicines with existing substances Glyibenklamide, glyclaside and glymepiride are slowly removed from the body and during long-term reception can accumulate in it, especially when kidney problems. Provoke hypoglycemic to whom the overdose of these funds can also.
  2. Significant physical activity, not supported by carbohydrate intake, with insulin-dependent diabetes.
  3. Used in diabetes mellitus of alcohol in significant quantities (more than 40 g in terms of alcohol) adversely affects the liver and inhibits glucose synthesis in it. Most often, the hypoglycemic coma in this case develops in a dream, in the pre-understanding hours.
  4. Insulinoma is a neoplasm capable of independently synthesize insulin. Large tumors producing insulin-like factors.
  5. Violations in the work of enzymes, more often hereditary.
  6. Hepatic and renal failure as a consequence of fat hepatosis or liver cirrhosis, diabetic nephropathy.
  7. GTS diseases that prevent glucose suction.

In diabetic neuropathy and alcoholic intoxication, the first manifestations of hypoglycemia are difficult, so you can skip a slight reduction in sugar and bring your condition to coma. Also erasing the symptoms is observed in patients with frequent light hypoglycemia. They begin to sense malfunctions in the body when sugar falls below 2 mmol / l, so they are less for emergency care. And on the contrary, diabetics with constantly high sugar signs of hypoglycemia begin to feel when sugar becomes normal.

What is characteristic of GK

Symptoms of hypoglycemia do not depend on the cause, it caused. In all cases, the clinical picture of the development of the coma is the same.

Normally, constant blood sugar is maintained even with a lack of carbohydrates due to the splitting of glycogen reserves and the formation of glucose in the liver from non-reliable compounds. When sugar decreases to 3.8, a vegetative nervous system is activated in the body, the processes aimed at preventing the hypoglycemic coma are being developed, insulin antagonist hormones are produced: first glucagon, then adrenaline, last time - growth hormone and cortisol. Symptoms of hypoglycemia at this time are a reflection of pathogenesis of such changes, they got the name "Vegetative". Diabetics with experience gradually decreases the secretion of glucagon, and then adrenaline, at the same time the initial signs of the disease are reduced, and the risk of hypoglycemic coma increases.

When glucose decreases to 2.7, neurogenic is added to the vegetative symptoms. Their appearance means the beginning of the defeat of the central nervous system. With a sharp drop of sugar, both groups of signs occur almost simultaneously.

The patient becomes difficult to concentrate attention, focus on the ground, thoughtfully respond to questions. He starts to hurt his head, dizziness is possible. There is a sense of numbness and tingling, most often in the nasolabial triangle. Fakes are possible, convulsions.

With a serious damage to the central nervous system, partial paralyts are added, voice violation, memory loss. First, the patient behaves inadequately, then he appears strong drowsiness, he loses consciousness and flows into someone. When in a comatose state without medical care, blood circulation is broken, breathing, they begin to refuse the organs, swells the brain.

First Aid Action Algorithm

Vegetative symptoms are easily eliminated by receiving a portion of fast carbohydrates. In terms of glucose usually sufficial. It is not recommended to exceed this dose, since an overdose may cause the opposite state - hyperglycemia. To raise blood glucose and improve the patient's condition, there is enough a pair of candy or pieces of sugar, half a cup of juice or sweet soda. Fast carbohydrates of diabetics are usually constantly carrying with them to start treatment in time.

Note! If the patient is assigned ancorage or miglitol, sugar will not be able to stop hypoglycemia, since these drugs block sucrose splitting. The first aid for the hypoglycemic coma in this case can be provided with pure glucose in tablets or solution.

When diabetics is still in consciousness, but can no longer help himself, to relieve hypoglycemia, he gives any sweet drink, following him that he does not choose. Dry products at this time are dangerous aspiration risk.

If the loss of consciousness occurred, you need to call an ambulance, put the patient on the side, check whether the respiratory tract is free and is free to sick. If necessary, artificial respiration is beginning to make.

Hypoglycemic coma can be completely eliminated before the arrival of the physicians, for this requires a set of prefigure. It includes a glucagon and syringe preparation for its introduction. Ideally, every diabetic should carry this kit with you, and its loved ones - be able to use it. This tool can quickly stimulate the production of glucose in the liver, so consciousness to the patient returns 10 minutes after injection.

Exceptions - coma due to alcohol intoxication and multiple excess of the dose of insulin or glyibenklamide. In the first case, the liver is engaged in purifying the body from the spree products of alcohol, in the second - glycogen reserves in the liver will be not enough to neutralize insulin.

Diagnostics

Signs of hypoglycemic coma are not specific. This means that they can be attributed to other states accompanying diabetes. For example, diabetics with constantly high sugar can feel hunger due to severe insulin resistance, and with diabetic neuropathy, heartbeats and sweating are possible. The convulsions before the coma is easy for epilepsy, and panic attacks have the same vegetative symptoms as hypoglycemia.

The only reliable way to confirm the hypoglycemia is a laboratory analysis that determines the level of glucose in plasma.

The diagnosis is made under the following conditions:

  1. Glucose is less than 2.8, while there are signs of the hypoglycemic coma.
  2. Glucose is less than 2.2, if such signs are not observed.

Also use the diagnostic sample - 40 ml of glucose solution (40%) is introduced into vein. If blood sugar decreased due to lack of carbohydrates or overdose of drugs during diabetes, the symptoms are immediately softened.

Part of the blood plasma, taken when entering the hospital, frozen. If, after eliminating coma, its reasons will not be revealed, this plasma is sent to a detailed analysis.

Hospital treatment

With a mild coma, consciousness is restored immediately after the diagnostic sample. In the future, diabetics will require only a survey to identify the cause of hypoglycemic disorders and correction of previously prescribed treatment of diabetes. If the patient did not come into consciousness, they diagnose hard to whom. In this case, the amount of intravenously introduced 40% glucose solution is increased to 100 ml. Then transition to permanent administration using a dropper or an infusion pump of a 10% solution until the blood sugar does not reach much / l.

If it turned out that the coma arose due to overdose of sugar-based funds, the stomach was washing and give enterosorbents. If a strong insulin overdose is likely and less than 2 hours have passed since the injection, it is excited by soft tissues at the injection site.

Simultaneously with the liquidation of hypoglycemia, its complications are treated:

  1. Diuretics with suspected brain edema - mannitol (15% solution at the rate of 1 g per kg of weight), then Laziks (mg).
  2. Nootrop piracetam improves blood flow in the brain and helps preserve cognitive abilities (10-20 ml of 20% solution).
  3. Insulin, potassium preparations, ascorbic acid, when blood sugar is already enough and it is necessary to improve its penetration into the tissue.
  4. Thiamine with suspected alcohol hypoglycemic to someone or exhaustion.

Complications of the hypoglycemic coma

Upon the occurrence of severe hypoglycemic states, the body is trying to prevent negative consequences for the nervous system - speeds up the emission of hormones, increases cerebral blood flow several times to enhance the inflow of oxygen and glucose. Unfortunately, compensatory reserves are able to prevent damage in the brain for a fairly short time.

If the treatment does not give the results more than half an hour, it is possible to say with a high probability that complications arose. If coma does not stop more than 4 hours, a great chance of severe irreversible neurological pathologies. Due to long starvation, brain swells develops, necrosis of individual sites. Because of the excess of catecholamines, the tone of the vessels decreases, the blood in them begins to be forced, thrombosis and small hemorrhages occur.

In the elderly diabetics, the hypoglycemic coma may be complicated by heart attacks and strokes, damage to the psyche. Reasonable consequences are possible - early dementia, epilepsy, Parkinson's disease, encephalopathy.

In the near future we will publish information.

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