Cerebral coma according to ICD 10. Hepatic coma: clinical development, treatment methods and prognosis

If a person abuses alcoholic beverages, taking large doses of ethyl alcohol, then severe intoxication of his body occurs. Its consequence may be the development of coma - a pathological condition in which the central nervous system is depressed, leading to the patient losing consciousness and lack of response to external and internal stimuli.

Causes

The entry of a toxic dose of ethyl alcohol into the blood is the main cause of the development of a life-threatening condition. Even a small amount of drunk vodka or cognac has a negative effect on the body of some people; poisoning occurs when the ethanol content in the red liquid reaches 0.2‰ (ppm). Alcoholic coma, which has code T51 according to ICD 10 (International Classification of Diseases), develops when the concentration of alcohol in the blood is from 0.3 to 7.0 ppm, and above 7.0-7.5‰ death occurs.

The occurrence of a pathological condition is influenced by the following factors:

1. The strength of the drink (the more degrees it contains, the more toxic it is).
2. A person’s weight (thin people get drunk faster than fat people).
3. Age (teenagers and older people perceive alcohol more difficultly).
4. Drinking alcohol on an empty stomach, without a snack (in the absence of food in the stomach, intoxication occurs faster).

In some cases, coma can develop in people who have drunk a little vodka and become drunk (this is typical for those who are not used to drinking strong drinks, chronic alcoholics and those who have an individual intolerance to alcohol).

Effect of ethanol on the brain

Ethanol has the ability to be quickly absorbed into the intestines (95%) and into the blood (5%). A small amount of it, entering the red liquid, dilutes it, accelerating the movement of red blood cells. As the dose increases, the reverse process occurs: dehydration and thickening of the liquid due to the fact that ethyl alcohol dissolves the membranes of red blood cells and they stick together, forming clots.

Clumped blood cells clog the capillaries of the brain and cause oxygen starvation of its tissues (hypoxia). This is manifested by overexcitement, cheerfulness, and euphoria in the drinker. Ethanol then has a neurotoxic effect on brain function, which leads to disruption of the cerebral cortex.

An increased amount of alcohol in nerve cells (neurons) destroys the connections between them and changes their structure. When these changes affect the medulla oblongata, a sharp drop in blood pressure occurs and the person loses consciousness, falling into a coma.

Hypovolemia

Hypovolemia is a decrease in circulating blood volume. It develops due to the fact that ethyl alcohol causes swelling of the brain tissue and the distribution of fluid in them is disrupted. This manifests itself in a person with weakness, decreased blood pressure and temperature, and convulsions. Hypovolemia can cause loss of consciousness.

Hypoglycemia

Hypoglycemia is a drop in glucose levels. Ethyl alcohol in the body is broken down by liver enzymes, but they cannot cope with large amounts of alcohol, so the level of glycogen carbohydrate decreases, which leads to a sharp drop in blood sugar. Due to energy starvation, overstrain of the nervous system occurs, which causes loss of consciousness and hypoglycemic coma. Low air temperature accelerates the development of the pathological condition, because if a person drinks in the cold (outside in winter), then he needs even more glucose for thermoregulation.

Stages

There are 3 stages of coma:

1. Superficial 1st degree or resorption.
2. Superficial 2nd degree.
3. Deep.

Each phase of pathology differs from others in its characteristic features.

Superficial 1st degree

Initially, severe intoxication is manifested in the victim by muscle contractions or cramps, an increase in blood pressure and increased heart contractions. The person feels nauseous or has a lot of saliva coming out of their mouth. Although the patient is still conscious, he no longer controls his actions. His breathing becomes hoarse, facial expressions and coordination of movements are impaired, and involuntary urination may occur.

The face takes on a purple hue, the pupils narrow, but still react weakly to bright light. If a person in this state is given ammonia to sniff, the reaction to the medicine will be positive. Resorption lasts from 4 to 6-7 hours. In this condition, the concentration of alcohol in the blood does not exceed 4 ppm, and thanks to ammonia the patient comes to his senses.

Superficial 2nd degree

The duration of this phase is from 10 to 12 hours. It differs from resorption by a decrease in excitation. Everything “freezes” in the victim:

1. Breathing decreases.
2. The muscles relax.
3. The rapid pulse is barely palpable.
4. Breathing slows down.
5. The pupils stop responding to light.

With a superficial coma of the 2nd degree, a person may still feel severe pain (if he fell and hit the ground), but he involuntarily has defecation and deurination. If the victim loses consciousness, then ammonia no longer helps him. The concentration of ethanol in the blood at this stage reaches 6-6.5 ppm.

Deep

With deep alcoholic pathology, a person’s condition worsens even more. He sweats a lot, although his body temperature drops to +35°C. Blood pressure drops, the pulse weakens and is almost not palpable. There is no reaction to light or pain. The respiratory system becomes compromised and the victim cannot take a deep breath. Due to oxygen starvation, the face turns blue and then turns white.

This condition can last up to 24 hours. If you do not provide help to the patient, he dies, because his blood already contains 7 or more ppm of alcohol. A high concentration of ethanol leads to the development of heart and kidney failure; a person stops breathing or chokes on vomit or suffocates with a sunken tongue.

Symptoms

The main signs of intoxication in the victim are: excessive salivation, problems with speech and breathing (wheezing, shortness of breath, inability to say anything), blueness of the skin of the face, absence or weak reaction to pain, convulsions, loss of consciousness. If sober people are near the victim, noticing the signs described above, they should provide him with first aid and call a doctor.

Diagnostics

When diagnosing, doctors pay attention to the external symptoms of coma and determine the neurological status of the victim (convulsions, reflexes, pupillary reaction to light, consciousness and sensitivity to pain). The alcoholic pathological state should be distinguished from other types of coma:

1. Neurological, occurring with head injuries and cerebrovascular accidents.
2. Somatic, arising from diabetes mellitus and hepatitis.
3. Toxic, caused by drinking alcohol with drugs or medications.

To carry out differentiated diagnostics, instrumental methods for studying organs and tissues are used: radiography, CT, ultrasound. To identify a pathological process in the brain, the patient is prescribed echoencephaloscopy.

Data from urine and blood tests for amylase and glucose levels are of great importance in making a diagnosis. To determine the depth of the lesion, an analysis is performed to determine the amount of alcohol in the red liquid.

First aid

Emergency first aid should be provided to the patient as soon as possible. It consists of performing the following actions:

1. Bring the victim who is outside into a warm room and cover him with a blanket or outerwear.
2. Place the patient on his stomach and turn his head to the side so that it hangs down slightly. This position will reduce the risk of suffocation and choking on vomit.
3. Clear the person's nose and mouth of mucus and food debris.
4. Apply a cold compress to your head.
5. Bring a cloth or cotton wool moistened with ammonia to the victim’s nose.
6. If the patient wakes up, give him a drink of warm, sweet water or weakly brewed tea with sugar to increase blood glucose levels.

If a person cannot be revived, you need to give him artificial respiration or chest compressions. All other actions can only be performed by an emergency doctor.

Treatment

Treatment of deep and superficial coma of the 2nd degree is carried out after hospitalization of the patient and diagnosis. Intensive therapy is prescribed to restore the functioning of various body systems.

With superficial

If a person has difficulty breathing, it is necessary to ensure the patency of the bronchi, clearing them of mucus, and the supply of oxygen. Then the absorption of ethanol into the blood and intestines should be prevented as quickly as possible, so the victim’s stomach is washed with clean water using a probe.

To remove alcohol from the body, the patient is given a drip and a solution of glucose and insulin is injected intravenously, and saline solution is administered to replenish fluid losses.

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

To reduce mucus in the lungs and salivation, Atropine is injected under the skin.

To restore the functioning of the central nervous system, patients are prescribed a large amount of vitamins (C, PP, B1, B6).

In order to prevent oxygen starvation of the brain, catheterization is performed with diuretics.

For severe

In case of deep coma, the patient is placed in intensive care. If the victim is unconscious, tracheal intubation is performed and a ventilator is connected. Then the gastric lavage is repeated. The patient is indicated for the above-described means of intensive therapy.

Additionally, anti-shock therapy is used: plasma substitutes are administered (Reopoliglyukin, Hemodez). To prevent disturbances in kidney function, a bilateral lumbar blockade with Novocaine is performed. If muscle protein breakdown (myoglobinuria) is suspected, the hemosorption method (extrarenal blood purification of toxins) is used. If blood pressure is greatly reduced, Prednisolone is administered for several days.

Recovery period

If the victim receives help in a timely manner, he can come out of the coma within a few hours. Afterwards, he will face a long period of recovery, the goal of which is to reduce the consequences of the pathological condition.

For the time prescribed by the doctor, the patient will need to take vitamin-mineral complexes and medications to improve the functioning of the liver, kidneys, and cerebral circulation. It will take more than one day to restore the water-salt balance in the body. The patient will need to adhere to the prescribed diet and do special exercises. Drinking alcohol is prohibited throughout the rehabilitation period.

Consequences

The consequences of the pathological condition are acute renal failure and pneumonia, and death if assistance is not provided in a timely manner.

If a person has been in a deep coma for anywhere from 24 hours to several weeks or months, a number of negative changes may occur in their body.

Upon regaining consciousness, the victim may lose the ability to speak and walk. A violation of his health will be indicated by: severe headache, swelling in the muscles and their subsequent atrophy, bleeding from the mucous membranes, frequent pneumonia. These conditions will bother a person for several years.

First aid: alcohol coma

Alcohol intoxication. emergency care for alcohol intoxication.

Due to brain damage, the patient’s memory deteriorates, and aggression, tearfulness, or lethargy may appear. The terrible consequence is the development of dementia and personality degradation.

Hibernation, lethargy, numbness Dictionary of Russian synonyms. stupor noun, number of synonyms: 3 lethargy (39) ... Synonym dictionary

SOPOR- SOPOR, pat. a sleep state observed in a number of diseases of the central nervous system and in severe general suffering (infection, intoxication). According to the patient's condition, S. occupies a middle place between drowsiness and coma. Under drowsiness usually... Great Medical Encyclopedia

- (from the Latin sopor, numbness, lethargy), deep depression of consciousness with loss of voluntary and preservation of reflex activity (in case of severe intoxication, traumatic brain injury, etc.). Further depression of consciousness leads to coma... Modern encyclopedia

- (from the Latin sopor, torpor, lethargy), deep depression of consciousness with loss of voluntary and preservation of reflex activity. Further depression of consciousness leads to coma... Big Encyclopedic Dictionary

- (lat. sopor numbness, sleep) one of the forms of deep disorder of consciousness, in which the patient has no reaction to the environment, reflex activity, reaction to strong stimuli and the possibility of mental activity are preserved; more often … Dictionary of foreign words of the Russian language

- (from the Latin sopor, numbness, lethargy), deep depression of consciousness with loss of voluntary and preservation of reflex activity. Further depression of consciousness leads to coma. * * * SUPOR SUPOR (from lat. sopor numbness, lethargy), deep... ... encyclopedic Dictionary

Sopor- (Latin sopor - unconsciousness) - a violation of consciousness, occupying an intermediate place between stunned consciousness and coma. Characterized by disconnection from reality, loss of self-perception, interruption of contacts with others, cessation of all types... ... Encyclopedic Dictionary of Psychology and Pedagogy

- (sopor; lat. unconsciousness; synonym: soporous state, subcoma) deep stage of stunning, in which there are no reactions to verbal treatment and only reactions to painful stimulation are preserved... Large medical dictionary

- (from Lat. sopor numbness, lethargy) deep depression of consciousness while maintaining Reflexes. The patient in S. is passive, indifferent, although he is able to respond to some strong external stimuli by calling out, persistent repeated orders, etc... Great Soviet Encyclopedia

I Sopor (lag. sopor unconsciousness) see Stunning. II Stupor (sopor; lat. “unconsciousness”; synonym: stuporous state, subcoma) is a deep stage of stupor, in which there are no reactions to verbal treatment and only reactions to pain are preserved... ... Medical encyclopedia

• Diaberic:
  • coma with or without ketoacidosis (ketoacidosis)
  • hypersmolar coma
  • hypoglycemic coma
• Hyperglycemic coma NOS

1 With ketoacidosis

• acidosis without mention of coma
• ketoacidosis without mention of coma

2† With kidney damage

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

3† With eye lesions

4† With neurological complications

5 With peripheral circulatory disorders

6 With other specified complications

7 With multiple complications

8 With unspecified complications

9 No complications

Included: diabetes (mellitus):

• labile
• with onset at a young age
• with a tendency towards ketosis

Excluded:

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

Included:

• diabetes (mellitus) (non-obese) (obese):
  • with onset in adulthood
  • with onset in adulthood
  • without a tendency to ketosis
  • stable
• non-insulin-dependent diabetes mellitus of young people

Excluded:

• diabetes:
  • associated with malnutrition (E12.-)
  • in newborns (P70.2)
  • during pregnancy, during childbirth and the postpartum period (O24.-)
• glycosuria:
  • NOS (R81)
  • renal (E74.8)
• impaired glucose tolerance (R73.0)
• postoperative hypoinsulinemia (E89.1)

[cm. the above subheadings]

Includes: diabetes mellitus associated with malnutrition:

• type I
• type II

Excluded:

• diabetes mellitus during pregnancy, childbirth and the postpartum period (O24.-)
• glycosuria:
  • NOS (R81)
  • renal (E74.8)
• impaired glucose tolerance (R73.0)
• diabetes mellitus of newborns (P70.2)
• postoperative hypoinsulinemia (E89.1)

[cm. the above subheadings]

Excluded:

• diabetes:
  • associated with malnutrition (E12.-)
  • neonatal (P70.2)
  • during pregnancy, during childbirth and the postpartum period (O24.-)
  • type I (E10.-)
  • type II (E11.-)
• glycosuria:
  • NOS (R81)
  • renal (E74.8)
• impaired glucose tolerance (R73.0)
• postoperative hypoinsulinemia (E89.1)

[cm. the above subheadings]

Includes: diabetes NOS

Excluded:

• diabetes:
  • associated with malnutrition (E12.-)
  • newborns (P70.2)
  • during pregnancy, during childbirth and the postpartum period (O24.-)
  • type I (E10.-)
  • type II (E11.-)
• glycosuria:
  • NOS (R81)
  • renal (E74.8)
• impaired glucose tolerance (R73.0)
• postoperative hypoinsulinemia (E89.1)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Emergency care and symptoms for hypoglycemic coma

Hypoglycemic coma is a critical condition of the endocrine system that occurs against the background of a sharp drop in blood sugar levels. Coma develops acutely. Sometimes the short-term period of precursors is so small that the coma begins almost suddenly - within a few minutes, loss of consciousness occurs and even paralysis of the vital centers of the medulla oblongata.

Blood glucose

Glucose is the main source of energy for the brain. Blood glucose levels are an important indicator of a person's health. A decrease in blood sugar levels, as well as an increase in it, triggers pathological processes in the body that can cause harm to health, even death. A normal glucose level is considered to be between 3.9 and 5 mol/L.

Unlike other organs, which are capable of receiving energy from other sources, for the brain, the supply of glucose is the only way of nutrition. With a sharp decrease in sugar concentration, brain cells begin to starve, and as its deficiency increases, their function is disrupted, and tissues undergo swelling, partial destruction and even death.

Hypoglycemic coma (code E-15 according to ICD-10) refers to a life-threatening human condition and is caused by a sharp decrease in blood glucose levels to less than 3 mm/l or its sharp changes with the subsequent development of acute starvation of the brain.

In most cases, adults and children with diabetes who are treated with insulin are at risk of developing hypoglycemic coma. However, in rare cases, hypoglycemic coma is possible in healthy people with a low-carbohydrate diet and severe stress.

Reasons for the development of hypoglycemic coma

The main reasons for the development of hypoglycemic coma are usually associated with a violation in the use of insulin in diabetes mellitus:

1. Injecting too much insulin. A sudden and excessive decrease in glucose concentration may occur, followed by hypoglycemia and coma.
2. Eating disorders after insulin administration. An important rule after administering insulin is to eat food containing carbohydrates in a timely manner - this prevents blood sugar from decreasing to too low a level under the influence of the administered dose.
3. Incorrect insulin administration. Insulin is administered subcutaneously; it gradually penetrates from the subcutaneous fat into the blood. If it is administered incorrectly intramuscularly, the effect of the drug is accelerated and intensified.
4. Incorrect insulin dose calculation. With increased physical activity or lack of sufficient carbohydrates in food, a dose adjustment of the drug is necessary.
5. When alcohol enters the body, it blocks glucose, which stops its delivery to the brain. That is why treating diabetes involves completely abstaining from drinking alcohol.

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

Symptoms of the condition

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

The main clinical symptoms of hypoglycemia:

• feeling of extreme hunger;
• nausea;
• pale skin accompanied by sweating;
• trembling in the limbs and throughout the body;
• changes in behavior and mood: anxiety, fear, aggression;
• impaired concentration and coordination of movements.

The development of hypoglycemia can be lightning fast, a sharp deterioration in the condition and the development of symptoms of hypoglycemic coma are possible in a matter of minutes.

With signs of hypoglycemic coma in the initial stage, there is an increase and intensification of all symptoms of hypoglycemia and, in the absence of help, the development of its final stages:

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

If a hyperglycemic coma occurs, first aid should be provided immediately by any person who is near the victim. To provide it, the most important task is to distinguish this condition from a hypoglycemic one, in which the therapeutic measures are completely opposite.

Difference between hypoglycemic coma and hyperglycemic coma

1. With hyperglycemia, the skin is dry, and cracks appear on the victim’s lips, while with hypoglycemia, extremely profuse sweating is observed.
2. With hyperglycemia, shortness of breath occurs, breathing is heavy and constricted. In hypoglycemic coma, breathing is often weakened or not changed at all.

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Emergency care for coma

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

Emergency care for hypoglycemic coma is to ensure that glucose enters the blood. If the patient is still conscious, you need to offer him candy or water with sugar dissolved in it. If consciousness is confused and the victim does not understand your words, you need to carefully open the patient’s mouth and try to pour sweet water under the tongue in small portions.

If signs of seizures occur, you must:

• lay the patient on his side, preferably on the floor;
• place a pillow or folded clothing under your head;
• if the jaws are not closed, it is advisable to place a soft object between the teeth;
• protect the patient from sharp and hard objects to avoid injury during convulsions.

Emergency care for hypoglycemic coma requires constant monitoring of the patient’s condition until doctors arrive.

Upon arrival of the ambulance, medical assistance begins immediately. After measuring blood sugar levels, doctors administer an intravenous stream of glucose and other drugs to normalize the patient's condition. After stabilization of the situation, hospitalization of the patient is required for further observation and treatment of possible consequences of hypoglycemic coma.

Disease prevention

Based on the main reasons for the development of an acute hypoglycemic state, prevention primarily includes timely treatment of diabetes mellitus, as well as the patient’s compliance 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 young patients and their teachers the signs of the onset of a hypoglycemic state and the rules for dealing with them.

Doctors usually recommend that you always carry candy with you to consume at the first sign of low blood sugar. Also, in many countries, patients with diabetes wear special cards or bracelets with the inscription “Diabetes” in order to inform others about the possible causes of the condition in case of loss of consciousness.

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Hypoglycemia

Hypoglycemia: Brief Description

Hypoglycemia - a decrease in blood glucose levels less than 3.33 mmol/l. Hypoglycemia can occur in healthy individuals after several days of fasting or several hours after a glucose load, resulting in increased insulin levels and decreased glucose levels in the absence of symptoms of hypoglycemia. Clinically, hypoglycemia manifests itself when the glucose level decreases below 2.4–3.0 mmol/l. The key to diagnosis is Whipple's triad: neuropsychic manifestations during fasting; blood glucose less than 2.78 mmol/l; relief of an attack by oral or intravenous administration of dextrose solution. The extreme manifestation of hypoglycemia is hypoglycemic coma.

Hypoglycemia: Causes

Risk factors

Genetic aspects

Etiology and pathogenesis

Fasting hypoglycemia Insulinoma Artificial hypoglycemia is caused by the use of insulin or taking oral hypoglycemic drugs (less commonly caused by taking salicylates, beta-blockers or quinine) Extrapancreatic tumors can cause hypoglycemia. These are usually large, abdominal tumors, most often of mesenchymal origin (eg, fibrosarcoma), although liver carcinomas and other tumors have been observed. The mechanism of hypoglycemia is poorly understood; report intensive uptake of glucose by some tumors with the formation of insulin-like substances Ethanol-induced hypoglycemia - in individuals with a significant reduction in glycogen stores due to alcoholism, usually 12–24 hours after binge drinking. Mortality is more than 10%, so rapid diagnosis and administration of dextrose solution are necessary (with the oxidation of ethanol into acetaldehyde and acetate, NADP accumulates and the availability of NAD, necessary for gluconeogenesis, decreases). Impairment of glycogenolysis and gluconeogenesis, necessary for the formation of glucose in the liver during fasting, leads to hypoglycemia. Liver diseases lead to deterioration of glycogenolysis and gluconeogenesis, sufficient to cause hypoglycemia on an empty stomach. Similar conditions are observed in fulminant viral hepatitis or acute toxic liver damage, but not in less severe cases of cirrhosis or hepatitis. Other causes of fasting hypoglycemia: deficiency of cortisol and/or growth hormone (for example, in adrenal insufficiency or hypopituitarism). Renal and heart failure are sometimes accompanied by hypoglycemia, but the causes of its occurrence are poorly understood.

Reactive hypoglycemia occurs several hours after consuming carbohydrates. Nutritional hypoglycemia occurs in patients after gastrectomy or other surgical intervention, leading to a pathologically rapid flow of food into the small intestine. Rapid absorption of carbohydrates stimulates excess insulin secretion, causing hypoglycemia some time after eating. Reactive hypoglycemia in diabetes. In some cases, patients in the early stages of diabetes experience a later but excessive release of insulin. After eating, the plasma glucose concentration increases after 2 hours, but then decreases to the level of hypoglycemia (3–5 hours after eating). Functional hypoglycemia is diagnosed in patients with neuropsychiatric disorders (for example, chronic fatigue syndrome).

Hypoglycemia: Signs, Symptoms

Clinical picture

Neurological symptoms predominate as glucose levels gradually decrease Dizziness Headache Confusion Visual disturbances (eg, diplopia) Paresthesia Seizures Hypoglycemic coma (often develops suddenly).

Adrenergic symptoms predominate with an acute decrease in glucose levels Hyperhidrosis Restlessness Tremor of the limbs Tachycardia and a feeling of interruptions in the heart Increased blood pressure Attacks of angina.

Age characteristics

Pregnancy

Hypoglycemia: Diagnosis

Laboratory research

The influence of drugs. Sulfonylurea stimulates the production of endogenous insulin and C-peptide, therefore, to exclude artificial hypoglycemia, a blood or urine test is performed for sulfonylurea drugs.

Special studies

Differential diagnosis

Hypoglycemia: Treatment Methods

Treatment

Lead tactics

Drugs of choice

Emergency medical care If it is impossible to take glucose orally, administer 40–60 ml of 40% dextrose solution intravenously for 3–5 minutes, followed by a continuous infusion of 5 or 10% dextrose solution. For neurological symptoms in children, treatment begins with an infusion of 10 % r - dextrose at a rate of 3–5 mg/kg/min or higher For hypoglycemia caused by oral hypoglycemic drugs (eg, sulfonylureas), continued dextrose infusion and observation of the patient for 24–48 hours is necessary due to the possibility relapse of coma.

It is possible to administer intramuscular or subcutaneous glucagon to the patient in the upper third of the shoulder or thigh (rarely used in our country). Glucagon usually resolves the neurological manifestations of hypoglycemia within 10–25 minutes; If there is no effect, repeated injections are not recommended. Doses of glucagon: children under 5 years old - 0.25-0.50 mg, children from 5 to 10 years old - 0.5-1 mg, children over 10 years old and adults - 1 mg.

Complications

ICD-10 E15 Non-diabetic hypoglycemic coma E16 Other disorders of endocrine pancreas P70 Transient disorders of carbohydrate metabolism specific to the fetus and newborn T38. 3 Poisoning with insulin and oral hypoglycemic [antidiabetic] drugs

Notes

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Hypoglycemia: classification, clinical picture and ICD-10 code

Hypoglycemia is a condition of the body in which there is a greatly reduced (compared to normal) concentration of glucose in the blood.

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

How does this pathology manifest itself and why is it dangerous? What is the ICD code for hypoglycemia and how is it treated? Let's take a closer look.

Classification of pathology

Has hypoglycemia code according to ICD 10 – 16.0. But this pathology has several classes:

• unspecified hypoglycemia – E2;
• hypoglycemic coma in the absence of diabetes mellitus – E15;
• 4 – disorders of gastrin synthesis;
• 8 – other disorders that were clarified during the examination of the patient;
• other forms – E1.

Other forms of hypoglycemia according to the ICD include hyperinsulinism and encephalopathy, which develops after coma caused by insufficient blood sugar.

Despite the fact that, according to the ICD classification, hypoglycemia has exactly the listed codes, when selecting medications for its relief and therapy, physicians should also be guided by the codes of external causes (class XX).

What is unspecified hypoglycemia?

ICD 10 describes unspecified hypoglycemia as a class 4 disease that can be caused by metabolic and/or endocrine disorders, as well as poor nutritional quality.

Classification by severity

There are three degrees of severity of hypoglycemia:

• light. When it occurs, the patient’s consciousness is not clouded, and he is able to personally correct his own condition: call an ambulance or, if this is not the first episode, take the necessary medications;
• heavy. When it occurs, the person is conscious, but cannot independently stop the manifestations of the pathology due to his severe depression and/or physiological disorders;
• hypoglycemic coma. It is characterized by loss of consciousness and its non-return for a long time. Without outside help, a person in this condition can suffer serious harm, even death.

Reasons for development

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Hypoglycemia can occur due to many factors, both exogenous (external) and endogenous (internal). Most often it develops:

• due to poor nutrition (in particular, with regular consumption of large amounts of carbohydrates);
• in women during menstruation;
• with insufficient fluid intake;
• in the absence of sufficient physical activity;
• against the background of transmitted infectious diseases;
• as a result of the appearance of neoplasms;
• as a reaction to diabetes therapy;
• due to diseases of the cardiovascular system;
• due to weakness of the body (in newborns);
• due to the abuse of alcoholic beverages and some other types of drugs;
• for liver, kidney, heart and other types of failure;
• with intravenous administration of physical solution.

The listed reasons are considered 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 determination, previous injuries, etc. Also, this condition may be a consequence of a sharp change in plasma glucose concentration from high to normal. Such glycemia is no less dangerous and can lead to disability or death of the patient.

A number of studies show that most often the pathological condition in question appears in people suffering from alcoholism. This is due to the fact that due to regular intake of ethyl alcohol, the body begins to use NAD abnormally quickly. Also, the process of gluconeogenesis begins to slow down in the liver.

Alcoholic hypoglycemia can occur not only due to frequent abuse of alcoholic beverages, but also with single use of large doses.

Doctors also diagnose cases where abnormally low blood sugar is found in people who have previously taken small doses of alcohol. The highest risk of developing this pathology after drinking ethanol is present in children.

Symptoms

Hypoglycemia is characterized by a complex of symptoms. When sugar in the body drops, the patient most often experiences mental agitation, as a result of which he may show aggressiveness and/or anxiety, restlessness and fear.

In addition, he may partially lose the ability to navigate in space and experience headaches. This condition is also characterized by significant physiological disturbances.

The patient almost always begins to sweat profusely, his skin turns pale, and his limbs begin to tremble. In parallel with this, he experiences a strong feeling of hunger, which, however, may (but not always) be accompanied by nausea. The clinical picture is complemented by general weakness.

Less frequent manifestations of this condition: blurred vision, impaired consciousness up to fainting, from which a person can fall into a coma, epileptiform seizures, noticeable behavioral disturbances.

Hypoglycemic coma

The ICD code for hypoglycemic coma is E15. This is an acute condition that occurs extremely quickly with a sharp drop in blood sugar.

Its initial manifestation is loss of consciousness. But, unlike ordinary fainting, the patient does not come out of it after a few seconds/minutes, but remains there at least until proper medical care is provided to him.

Often the period between the first symptoms of hypoglycemia and the fainting itself is very short. Neither the patient nor those around him notice the warning signs of the onset of coma, and it seems sudden to them. Hypoglycemic coma is the extreme degree of this pathological condition.

Despite the fact that the clinical manifestations preceding coma often go unnoticed, they are present and are expressed in the following: heavy sweating, vasospasm, changes in heart rate, feeling of tension, etc.

Hypoglycemic coma is a reaction of the central nervous system to a sharp change in the direction of decreasing glycemic concentration in the blood vessels of the brain.

During its development, disturbances first occur in the neocortex, then in the cerebellum, after which the problem affects the subcortical structures, and ultimately reaches the medulla oblongata.

Most often, coma occurs as a result of the introduction of an incorrect dosage of insulin into the body (if the patient has diabetes). If a person does not suffer from this pathology, then it can also develop as a result of ingestion of food or sulfonamide medications.

Useful video

The most effective ways to treat and prevent hypoglycemia:

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

Causes and help for hypoglycemic coma

Hypoglycemic coma is a pathology of the nervous system, which is caused by a severe lack of glucose in the human body. Without it, most organs weaken and gradually lose their functionality. If you do not start a course of therapy in a timely manner, everything can end in death. Competent first aid for hypoglycemic coma is what will save a person’s life. Hypoglycemic coma has an ICD 10 code.

Causes of the condition

The causes of the disease are:

• inability to block this condition during the development of diabetes mellitus;
• excessive alcohol consumption;
• excessive course of medication;
• stress: lack of sleep, malnutrition, anxiety, nervous breakdowns, etc.;
• problems with the liver and pancreas (its tumor), liver failure;
• excess insulin dose.

The latter happens not only due to error or ignorance. When introducing a substance, it is important to correctly calculate its combination with physical activity and carbohydrate intake. People sometimes have false information about the rules of the procedure:

• insulin is administered intravenously rather than intramuscularly;
• after taking it, you need to take a meal rich in carbohydrates;
• Excessive physical activity is prohibited. They are set by a doctor, because any unplanned activity must be accompanied by professional adjustments in insulin dosage and a nutritional program for carbohydrate intake for the day.

Symptoms

Hypoglycemia is a chronic disease, pathogenesis. Without treatment, the person will be susceptible to complications. The first signs are mild, and the patient rarely pays attention to them. Among them: lethargy, fatigue and headaches, which cannot be relieved with the help of conventional tonics and painkillers.

The classification of symptoms is as follows:

• 1) Autonomic / parasympathetic / adrenergic. These include: constant nervous tension, breakdowns, stress; excessive aggressiveness, anger, rage and feelings of restlessness, anxiety, excitement; profuse sweating; convulsions, constant trembling in the limbs; high blood pressure; heartbeat disturbance; pallor; constant feeling of nausea and hunger; lethargy, drowsiness, fatigue.
• 2) Neuroglycopenic. Symptoms of this group: poor concentration, loss of attention; dizziness, glare before the eyes, severe headache; drowsiness, developing chronic fatigue syndrome, lethargy; split image; disorientation in space; hallucinations; paranoia; frequent amnesia; circulatory disorders; breathing problems, shortness of breath; breakdowns and inappropriate behavior; fainting or a condition preceding it.

A precomatose state is determined by clonic or tonic convulsions and an epileptiform seizure. These signs cannot be predicted; they occur spontaneously, which puts a person’s life at risk.

In a child, these manifestations progress twice as fast as in an adult. The set of symptoms is identical. A fatal outcome occurs more likely and unexpectedly.

Complications

The first stage of the disease is determined by a decrease in blood sugar levels. Glucose is the main source of energy for the functioning of brain cells. It stops receiving substances for stable functioning. Afterwards, the cells begin to generate the necessary force from reserve substances that are not designed for such work. This self-regulation is supported by glucagon, a pancreatic hormone. The body is gradually depleted, and in children it stops developing. Due to a sharp lack of microelements, the brain stops receiving a standard dose of oxygen.

If emergency assistance is not provided in a timely manner, the disease will lead to swelling of the brain and disruption of the functioning of the central nervous system (CNS). Such deviations are already irreversible. An adult is faced with a complete change in personality and individual habits, routine, behavior, character and perception of the world around him. The child suffers from a sharp drop in intelligence level down to the lowest possible threshold. Older people are at increased risk if they have coronary artery disease of the brain or heart and cardiovascular disease. Complications here include myocardial infarction and stroke.

With frequent attacks of coma, the occurrence of encephalopathy is predicted. This is a type of organic brain abnormality that was caused in a non-inflammatory way. It is accompanied by a severe degree of oxygen starvation and pathology in the process of blood supply. As a result, local personality degradation and deviations in the functioning of the central nervous system occur.

Lack of insulin can also trigger insulin shock, a clinical condition characterized by a sudden loss of consciousness due to a noticeable decrease in blood sugar. The second threat is hypoglycemic shock - a sudden severe decrease in glucose levels, followed by coma. Diabetic ketoacidotic coma is also provoked by a sharp lack of insulin.

It is impossible to avoid death in 40% of cases after a hypoglycemic coma.

Emergency care for hypoglycemic coma

Emergency care for hypoglycemic coma can save a person’s life and prevent the occurrence and development of pathologies caused by the condition.

Signs of coma are a reaction to stress in the medulla oblongata. Observed:

• absolute loss of consciousness;
• dilated pupils;
• sudden pallor;
• sticky cool sweat on the face;
• weakened breathing;
• high or standard blood pressure, heartbeat, pulse;
• reflexes in the elbows and knees are more pronounced.

The main thing is to return the person to consciousness and bring the body’s main indicators back to normal.

The stories of witnesses to the event will help to distinguish a hypoglycemic coma from any other. Passers-by can easily point out signs of damage. Only after this can you confidently begin to take action.

The first stage of care for hypoglycemic coma:

• It is necessary to raise your blood sugar level. To do this, carry out the irritation procedure: create sharp pain through tingling or hitting the cheeks. This will provoke the release of catecholamines into the blood and bring the person to his senses, after which he must be taken to the nearest hospital or make an emergency call to an ambulance and contact the patient’s relatives if he is unable to do this on his own.
• This method is acceptable and effective only for mild coma. Otherwise, you will not be able to bring the victim out of this state - only a doctor will help. But the administration of glucose is still necessary: ​​this will help avoid serious damage to the brain, central nervous system and disruption of their functioning. The insulin injection is given intravenously. This will save a person's life. As a rule, patients with diabetes always have a first aid kit on hand, where you will find all the means for carrying out the “operation”. Afterwards resuscitation is needed.

Treatment

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

When treating coma, the most important thing is to make the correct diagnosis. Unknowingly, administering an injection with a glucose solution can easily provoke the death of the patient.

The treatment algorithm in the early stages can also be followed at home. The mechanism is simple: it is enough to take a specific dose of fast carbohydrates. They are found in white bread, cakes, honey, and cornflakes. Drink a sugar solution: mix three teaspoons with a glass of warm water. During a prolonged attack, it is necessary to consume sugar at set intervals (every minute) with the same dosage.

In severe cases of damage, a person is sent to a clinic, where he will be examined. He is prescribed inpatient treatment for hypoglycemic coma. A jet intravenous injection of a forty percent glucose solution in an amount of up to one hundred milliliters is carried out. Therapy begins with subcutaneous injection of adrenaline along with glucagon or hydrocortisone. If after a couple of hours the patient does not come to his senses, glucose is administered by drip 4 times a day and intramuscularly every hour and a half. To avoid dehydration and water intoxication, a solution of glucose is introduced in sodium chloride. For prolonged coma, mannitol is used.

The main treatment is aimed at restoring glucose metabolism. Intramuscularly, the nurse administers 100 ml of carboxylase and 5 ml of five percent ascorbic acid. Humidified oxygen tones the functioning of the brain and heart, improves the functioning of blood vessels.

Prevention

It is much easier to prevent any disease than to cure it.

Principles and methods of pre-medical prevention:

• compliance with the established daily routine;
• giving up bad habits (alcohol and smoking);
• proper nutrition;
• compliance with recommendations for controlling the carbohydrate content in food consumed.

A diabetic should use glucose-lowering medications and monitor glucose levels. He should know the glucose index in various products and the consequences of exceeding it. There is an international table of diabetic foods that can be eaten. It is important to know the etiology: symptoms and signs of hypoglycemia, pathophysiology, methods of prevention.

If the course of treatment includes antidiabetic medications and tablets such as anticoagulants, beta-blockers, salicylates, tetracycline, anti-tuberculosis drugs, medications, then blood sugar must be monitored especially carefully.

It is necessary to carry out laboratory diagnostics every 2-3 months and undergo an ECG to check for hypoglycemia. A medical examination will identify possible abnormalities through a test, conduct an examination and tell you what your glucose level is.

Thus, hypoglycemic coma is a condition whose symptoms are difficult to confuse with anything else. Treatment must be urgent, and prevention involves lifestyle control and treatment of the underlying disease.

The information on the site is provided solely for popular informational purposes, does not claim to be reference or medical accuracy, and is not a guide to action. Do not self-medicate. Consult your healthcare provider.

Hypoglycemic coma (signs, emergency care algorithm and consequences)

The consequences of diabetes mellitus are mostly delayed; the patient usually has enough time to notice symptoms, consult a doctor, and adjust therapy. Hypoglycemic coma, unlike other complications, cannot always be prevented and stopped in time, since it develops rapidly and quickly deprives a person of the ability to think rationally.

In this condition, the patient can only count on the help of others, who do not always have information about diabetes and may confuse coma with ordinary alcohol intoxication. To maintain health, and even life, a diabetic needs to learn to avoid a strong drop in sugar, reduce the dose of medications in a timely manner when there is a high probability of provoking a coma, and identify hypoglycemia at the first signs. It would be useful to learn the rules of emergency care for coma and familiarize your loved ones with them.

Hypoglycemic coma - what is it?

Hypoglycemic coma is a severe, acute condition, dangerous due to severe starvation of body cells, damage to the cerebral cortex and death. Its pathogenesis is based on the cessation of glucose supply to brain cells. Coma is a consequence of severe hypoglycemia, in which blood sugar levels drop significantly below a critical level - usually less than 2.6 mmol/l when the norm is 4.1.

Most often, coma occurs due to diabetes mellitus, especially in patients who are prescribed insulin medications. Severe hypoglycemia can also develop in elderly diabetics who take medications that enhance the synthesis of their own insulin for a long time. Typically, a coma is prevented on its own or eliminated in a medical facility if the patient was delivered there in a timely manner. Hypoglycemic coma causes death in 3% of diabetics.

This condition may also be a consequence of other diseases in which excess insulin is produced or glucose stops flowing into the blood.

• E0 – coma in type 1 diabetes,
• E11.0 – 2 types,
• E15 – hypoglycemic coma not associated with diabetes mellitus.

Reasons provoking the violation

Hypoglycemic coma is provoked by prolonged habitual hypoglycemia or a sharp drop in sugar. They can be caused by the following factors:

1. Violations in the use or administration of insulin preparations:

• increasing the dose of short-acting insulin due to incorrect 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 insulin administration, there was no food intake;
• replacing the drug without dose adjustment if the previous one was weaker, for example, due to improper storage or expired expiration date;
• inserting the syringe needle deeper than required;
• enhancing the action of insulin due to massage or warming the injection site.

1. Taking hypoglycemic agents related to sulfonylurea derivatives. Medicines with the active ingredients glibenclamide, gliclazide and glimepiride are slowly eliminated from the body and, when taken for a long time, can accumulate in it, especially with kidney problems. An overdose of these drugs can also provoke a hypoglycemic coma.
2. Significant physical activity, not supported by carbohydrate intake, in insulin-dependent diabetes.
3. Drinking alcohol in significant quantities during diabetes mellitus (more than 40 g in terms of alcohol) negatively affects the liver and inhibits the synthesis of glucose in it. Most often, hypoglycemic coma in this case develops during sleep, in the early morning hours.
4. Insulinoma is a neoplasm that can independently synthesize insulin. Large tumors that produce insulin-like factors.
5. Disturbances in the functioning of enzymes, often hereditary.
6. Liver and kidney failure as a result of fatty hepatosis or cirrhosis of the liver, diabetic nephropathy.
7. Gastrointestinal diseases that interfere with glucose absorption.

With diabetic neuropathy and alcohol intoxication, the first manifestations of hypoglycemia are difficult to feel, so you can miss a slight decrease in sugar and bring your condition to a coma. Also, erasure of symptoms is observed in patients with frequent mild hypoglycemia. They begin to feel problems in the body when sugar drops below 2 mmol/l, so they have less time for emergency help. On the contrary, diabetics with constantly high sugar levels begin to feel signs of hypoglycemia when their sugar levels become normal.

What is characteristic of GC

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

Normally, constant blood sugar is maintained even with a lack of carbohydrates due to the breakdown of glycogen stores and the formation of glucose in the liver from non-carbohydrate compounds. When sugar drops to 3.8, the autonomic nervous system is activated in the body, processes begin to prevent hypoglycemic coma, insulin antagonist hormones are produced: first glucagon, then adrenaline, and lastly growth hormone and cortisol. Symptoms of hypoglycemia at this time are a reflection of the pathogenesis of such changes; they are called “vegetative”. In experienced diabetics, the secretion of glucagon and then adrenaline gradually decreases, while the initial signs of the disease decrease and the risk of hypoglycemic coma increases.

When glucose drops to 2.7, the brain begins to starve, and neurogenic symptoms are added to the vegetative symptoms. Their appearance signifies the onset of damage to the central nervous system. With a sharp drop in sugar, both groups of symptoms appear almost simultaneously.

It becomes difficult for the patient to concentrate, navigate the area, and answer questions thoughtfully. His head begins to hurt and he may feel dizzy. A feeling of numbness and tingling appears, most often in the nasolabial triangle. Double objects and convulsions are possible.

With serious damage to the central nervous system, partial paralysis, speech impairment, and memory loss are added. At first the patient behaves inappropriately, then he becomes extremely drowsy, loses consciousness and falls into a coma. When in a comatose state without medical help, blood circulation and breathing are disrupted, organs begin to fail, and the brain swells.

First aid algorithm

Vegetative symptoms are easily eliminated by taking a portion of fast carbohydrates. In terms of glucose, usually a gram is sufficient. It is not recommended to exceed this dose, since an overdose can cause the opposite condition - hyperglycemia. To raise blood glucose and improve the patient’s condition, a couple of sweets or pieces of sugar, half a glass of juice or sweet soda are enough. Diabetics usually carry fast carbohydrates with them at all times in order to start treatment on time.

Note! If the patient is prescribed acarbose or miglitol, sugar will not be able to stop hypoglycemia, since these drugs block the breakdown of sucrose. First aid for hypoglycemic coma in this case can be provided with pure glucose in tablets or solution.

When the diabetic is still conscious, but can no longer help himself on his own, to relieve hypoglycemia, he is given any sweet drink, making sure that he does not choke. Dry foods at this time pose a risk of aspiration.

If loss of consciousness occurs, you need to call an ambulance, lay the patient on his side, check whether the airways are clear and whether the patient is breathing. If necessary, begin artificial respiration.

Hypoglycemic coma can be completely eliminated even before the arrival of doctors; for this, a first aid kit is required. It includes the drug glucagon and a syringe for its administration. Ideally, every diabetic should carry this kit with them, and their loved ones should be able to use it. This drug can quickly stimulate the production of glucose in the liver, so the patient’s consciousness returns within 10 minutes after the injection.

Exceptions are coma due to alcohol intoxication and multiple excess doses of insulin or glibenclamide. In the first case, the liver is busy cleansing the body of alcohol breakdown products, in the second, the glycogen reserves in the liver will not be enough to neutralize insulin.

Diagnostics

Signs of hypoglycemic coma are not specific. This means that they can also be attributed to other conditions accompanying diabetes mellitus. For example, diabetics with persistently high blood sugar may feel hungry due to severe insulin resistance, and diabetic neuropathy may cause heart palpitations and sweating. Convulsions before the onset of coma can easily be mistaken for epilepsy, and panic attacks have the same autonomic symptoms as hypoglycemia.

The only reliable way to confirm hypoglycemia is a laboratory test that determines plasma glucose levels.

The diagnosis is made under the following conditions:

1. Glucose is less than 2.8, with signs of hypoglycemic coma present.
2. Glucose is less than 2.2, if such signs are not observed.

A diagnostic test is also used - 40 ml of glucose solution (40%) is injected into a vein. If blood sugar has dropped due to a lack of carbohydrates or an overdose of diabetes medications, the symptoms immediately alleviate.

Part of the blood plasma taken upon admission to the hospital is frozen. If, after eliminating the coma, its causes are not identified, this plasma is sent for detailed analysis.

Hospital treatment

In mild coma, consciousness is restored immediately after the diagnostic test. In the future, the diabetic will only need an examination to identify the cause of hypoglycemic disorders and correction of previously prescribed treatment for diabetes. If the patient does not regain consciousness, a severe coma is diagnosed. In this case, the amount of intravenously administered 40% glucose solution is increased to 100 ml. Then they switch to continuous administration of a 10% solution using a dropper or infusion pump until the blood sugar reaches mmol/l.

If it turns out that the coma occurred due to an overdose of hypoglycemic drugs, gastric lavage is done and enterosorbents are given. If a severe overdose of insulin is likely and less than 2 hours have passed since the injection, excision of the soft tissue at the injection site is performed.

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

1. Diuretics for suspected cerebral edema - mannitol (15% solution at the rate of 1 g per kg of weight), then Lasix (mg).
2. The nootropic Piracetam improves blood flow in the brain and helps maintain cognitive abilities (10-20 ml of a 20% solution).
3. Insulin, potassium supplements, ascorbic acid, when there is already enough sugar in the blood and you need to improve its penetration into the tissues.
4. Thiamine for suspected alcoholic hypoglycemic coma or exhaustion.

Complications of hypoglycemic coma

When severe hypoglycemic conditions occur, the body tries to prevent negative consequences for the nervous system - it accelerates the release of hormones, increases cerebral blood flow several times in order to increase the flow of oxygen and glucose. Unfortunately, compensatory reserves can prevent damage to the brain within a fairly short time.

If treatment does not produce results for more than half an hour, it is highly likely that complications have arisen. If the coma does not stop for more than 4 hours, there is a high chance of severe irreversible neurological pathologies. Due to prolonged fasting, cerebral edema and necrosis of certain areas develop. Due to an excess of catecholamines, vascular tone decreases, blood begins to stagnate in them, thrombosis and minor hemorrhages occur.

In elderly diabetics, hypoglycemic coma can be complicated by heart attacks and strokes, and mental damage. Long-term consequences are also possible - early dementia, epilepsy, Parkinson's disease, encephalopathy.

We will publish information soon.

Coma- unconsciousness caused by dysfunction of the brain stem.

Code according to the international classification of diseases ICD-10:

• R40.2

Causes

Etiology: traumatic brain injury, stroke, infection, status epilepticus, brain tumors, exogenous intoxications, systemic metabolic disorders (diabetes mellitus, hypoglycemia, uremia, eclampsia, thyrotoxicosis), etc. A decisive role in the development of coma is played by damage to the ascending activating systems of the brain stem and interstitial brain.

Symptoms, course. Depending on the severity of impairment of vital functions, coma is divided into several degrees. In mild coma, patients respond to painful stimuli; reflexes from the nasal mucosa, corneal and pupillary, are preserved; sometimes tendon reflexes persist and Babinski's sign is caused. Severe degree of coma: reaction only to intense painful stimuli, swallowing is impaired, but when food enters the respiratory tract, a reflex cough occurs; stertorous breathing, often of the Cheyne-Stokes type. Deep coma: areflexia, atony, mydriasis, severe respiratory and circulatory disorders. Transcendental (terminal) coma: the patient’s vital activity is maintained only through artificial ventilation of the lungs and stimulation of the heart.

Treatment

Treatment. When establishing the nature of coma, pathogenetic therapy is used. At all stages of coma - resuscitation measures.

Forecast depends on the cause of the coma and the severity of the brainstem damage. In deep coma, the prognosis is often unfavorable; absolutely unfavorable prognosis for extreme coma.

Diagnosis code according to ICD-10. R40.2