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| ==Background== | | ==Definition== |
| *State of reduced alertness and responsiveness from which the pt cannot be aroused | | *State of reduced alertness and responsiveness from which the patient cannot be aroused |
| *Must quickly determine if coma is from diffuse or focal impairment
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| *Peds
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| **Most common causes are toxic ingestion, infection, and child-abuse induced trauma
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| ==Clinical Features==
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| *Depends on cause
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| **Diffuse brain dysfunction - lack of focal findings
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| ***Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes
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| ==DDX==
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| #Diffuse brain dysfunction
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| ##Encephalopathies
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| ###Hypoxic encephalopathy
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| ###Metabolic encephalopathy
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| ####Hypoglycemia
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| ####Hyperosmolar state (e.g., hyperglycemia)
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| ####Electrolyte abnormalities (hypernatremia or hyponatremia, hypercalcemia)
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| ####Organ system failure
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| ####Hepatic encephalopathy
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| ####Uremia/renal failure
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| ####Endocrine (Addison disease, hypothyroidism)
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| ####Hypoxia
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| ####CO2 narcosis
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| ###Hypertensive encephalopathy
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| ##Toxins
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| ##Drug reactions (NMS)
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| ##Environmental causes
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| ###Hypothermia
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| ###Hyperthermia
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| ##Deficiency state
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| ###Wernicke encephalopathy
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| ##Sepsis
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| #Primary CNS disease or trauma
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| ##Direct CNS trauma
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| ###Diffuse axonal injury
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| ###Subdural/epidural hematoma
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| ##Vascular disease
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| ###Intraparenchymal hemorrhage
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| ##SAH
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| ##Infarction
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| ###Hemispheric, brainstem
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| ##CNS infections
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| ##Neoplasms
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| ##Seizures
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| ###Nonconvulsive status epilepticus
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| ####Consider if motor activity of seizure has stopped but pt is not alert w/in 30min
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| ###Postictal state
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| ==Work-Up==
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| *Head CT
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| ==Treatment==
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| *Pts w/ focal findings may have surgically treatable cause
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| *Coma cocktail
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| **Glucose, thiamine, naloxone
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| ==See Also== | | ==See Also== |
| *[[Glasgow Coma Scale (GCS)]] | | *[[Altered Mental Status]] |
| *[[GCS (Peds)]] | | *[[Persistent Vegetative State]] |
| *[[AVPU Scale]]
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| *[[Brain Death]]
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| ==Source==
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| Tintinalli
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| [[Category:Neuro]] | | [[Category:Neurology]] |
| | [[Category:Symptoms]] |
