Ver el código de «Coma»

==Background==
*State of reduced alertness and responsiveness from which the pt cannot be aroused
*Must quickly determine if coma is from diffuse or focal impairment
*Peds
**Most common causes are toxic ingestion, infection, and child-abuse induced trauma

==Clinical Features==
*Depends on cause
**Diffuse brain dysfunction - lack of focal findings
**Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes

==DDX==
#Diffuse brain dysfunction 
##Encephalopathies
###Hypoxic encephalopathy
###Metabolic encephalopathy
####Hypoglycemia
####Hyperosmolar state (e.g., hyperglycemia)
####Electrolyte abnormalities (hypernatremia or hyponatremia, hypercalcemia)
####Organ system failure
####Hepatic encephalopathy
####Uremia/renal failure
####Endocrine (Addison disease, hypothyroidism)
####Hypoxia
####CO2 narcosis
###Hypertensive encephalopathy
##Toxins
##Drug reactions (NMS)
##Environmental causes
###Hypothermia
###Hyperthermia
##Deficiency state
###Wernicke encephalopathy
##Sepsis
#Primary CNS disease or trauma 
##Direct CNS trauma
###Diffuse axonal injury
###Subdural/epidural hematoma
##Vascular disease
###Intraparenchymal hemorrhage
##SAH
##Infarction
###Hemispheric, brainstem
##CNS infections
##Neoplasms
##Seizures
###Nonconvulsive status epilepticus
####Consider if motor activity of seizure has stopped but pt is not alert w/in 30min
###Postictal state

==Work-Up==
*Head CT

==Treatment==
*Pts w/ focal findings may have surgically treatable cause
*Coma cocktail
**Glucose, thiamine, naloxone

==See Also==
*[[Glasgow Coma Scale (GCS)]]
*[[GCS (Peds)]]
*[[AVPU Scale]]
*[[Brain Death]]

==Source==
Tintinalli

[[Category:Neuro]]