What is a coma? Symptoms of coma, stages and classification

The term "coma" is borrowed from the Greek language and in literal translation means "deep sleep".

What is a coma?

Symptoms of coma are the inhibition or severe inhibition of the central nervous system. It is necessarily accompanied by loss of consciousness. The person does not react to light, sound and other external stimuli. The regulation of the main important functions of the body is disturbed. Coma, as a rule, is a dangerous complication of a disease, which complicates the process of recovery. Depending on the reasons that entail a coma, it can develop either rapidly, as in the case of craniocerebral trauma, or gradually. The main signs of coma may occur over a period of several hours or days, and with timely treatment, worsening conditions can be avoided. Thus, who should be considered as an acute pathological condition, which requires complex therapy in the early stages of manifestation. Therefore, the diagnosis of "coma" is put not only to a patient who does not fully react to external factors, but also in the event of a disconnection of consciousness with preservation of the basic reflexes.

The clinical picture of the development of coma is formed from an understanding of the algorithm of its manifestation, as well as from the knowledge of diseases and various pathologies, such as diabetes, poisoning with sleeping pills and psychotropic substances, uremia, which can bring to this state.

Types of coma

There are a lot of diseases, complications of which can become a coma. Signs of coma, its etiology was studied in detail by N.K. Bogolepov, having counted more than 30 species of this condition. Only a small part of the scientist isolated into independent diseases, the rest became syndromes and complications. It is worth noting that not necessarily the same disease in different people can cause a coma. The essence of the problem lies in the violation of biochemical homeostasis, hemodynamics and other problems associated with the normal functioning of the brain. Systematization of coma has led to the formation of the following subsections.

Coma of a neurological nature

They are directly related to the defeat of the central nervous system. To them it is possible to carry:

• To whom, arising at insults;
• Apoplectiform to whom;
• Epileptic state of coma;
• To whom, caused by trauma, for example, craniocerebral;

• A coma caused by the course of inflammatory processes, as well as good and malignant neoplasms in the brain and its membranes.

Coma in endocrine disorders

What is the cause of this coma? Symptoms of coma manifest in the form of a malfunction in the metabolic processes of the body due to insufficient or excessive production of hormones. If they are synthesized a little, then coma happens

• Diabetic;
• Hypokorticoid;
• Hypothyroid;
• Hypopituitary.

If the body produces a lot of hormones or the dosage of hormonal drugs is incorrect, then thyrotoxic and hypoglycemic coma may develop.

If the water-electrolyte balance of the organism is disturbed

If the human body experiences dehydration, lack of macro- and microelements, salts and substances necessary to fill energy losses, it can also fall into a coma. In this situation, two basic types are distinguished:

• Chlorhydropenic coma, which happens if the patient does not stop vomiting for a long time, for example, as in the case of stenosis of the pylorus;
• Alimentary-dystrophic coma, in other words, coma from hunger.

Disrupted gas exchange, which causes a coma

Signs of this type are the lack of incoming oxygen, in the problems of the respiratory system. They include:

• Hypoxic coma caused by a lack of oxygen coming from the outside (it occurs in case of suffocation, hypobaric hypoxemia, as well as in anemia, when the blood is not saturated with oxygen, and with various circulatory disorders);
• Respiratory coma, which, in turn, is divided into respiratory-cerebral and respiratory-acidotic.

Respiratory insufficiency caused by oxygen starvation, hypercapnia, global disturbance of gas exchange processes in the lungs are common symptoms of coma of this subspecies.

Coma due to intoxication of the body

It stands out as a separate group, as it is provoked by endogenous intoxications accompanying toxoinfections, various infectious ailments, pancreatitis, renal and hepatic insufficiency, or the effect on the body of chemical poisons: phosphorus organic compounds, alcohol, drugs belonging to the barbiturate group, And other medicines.

In addition to this rigid classification, there are coma of unknown or mixed etiology, in which one clear cause can not be identified, for example, in the case of a thermal coma caused by overheating of the entire human body. Although some sources refer it to a neurological group.

Below, we will examine the individual types of comatose states that occur more often than others.

Diabetic coma: classification

Diabetic coma, the signs of which will be considered later, is caused by a shortage of insulin in the body of patients with diabetes, can manifest itself in three variants: hyperketonemic, hyperosmolar, hyperlactacidemic. Sometimes it is called a "cerebral coma," since during its course cerebral edema is observed due to the fact that when the level of insulin decreases, the osmolarity of the brain and blood cells varies unequally.

When the blood sugar level is greatly increased, there is a hyperglycemic coma. It is most dangerous for children and elderly people. It develops gradually, as a rule, for several days.

Symptoms of hyperglycemic coma:

• Breath with the smell of acetone;
• Pallor and dryness of the skin;
• Loss of appetite;
• Narrowing of the pupils;
• Pain in the abdomen;
• tachycardia;
• Decreased muscle tone;
• Confusion of creation.

As soon as the first signs of a coma begin to appear, it is necessary to urgently call an ambulance. If you do not do it in time, a person stops responding to external factors and influences.

Hypoglycemic coma

In diabetics, sugar can not only increase sharply, but also decrease. This happens because of long breaks between meals, excessive physical exertion or in the case of drinking alcohol. Hypoglycemic coma, the signs of which are described below, develops very rapidly. Its harbingers may be:

• A strong sense of hunger;
• anxiety;
• Irritable and restless condition;
• Decreased body temperature;
• Shallow breathing;
• Increased sweating;
• Nausea, migraine;
• cardiopalmus;
• Visual disturbances;
• Inhibited consciousness;
• Dilated pupils ;
• Muscular hypertonia.

When all or part of the symptoms are manifested, emergency care is needed, consisting of intravenous administration, if necessary repeatedly, of a solution of glucose and subcutaneous - adrenaline.

Stages of coma

It has been established that there are a number of reasons why a coma develops, Symptoms of a coma of a particular etiology determine the severity of the process, as a result of which several stages of the coma have been identified.

1. Prekoma. Here the patient is characterized by several rather contradictory signs. On the one hand, there is a blurred consciousness, disruptions in spatial orientation, slowness, and on the other, there may be increased excitability, a disruption in coordination, but the basic rephalics remain intact.
2. Coma of the first degree. This is when the patient practically does not go to contact, does not react to external stimuli, very weakly feels even severe pain, hypertension of muscles and insensitivity of skin receptors are observed. Pupils in this case respond to light, but they may diverge in different directions, as with strabismus.
3. Coma of the second degree is due to a complete lack of contact, it is almost impossible to cause a pain reaction: a person can open his eyes to a maximum. There is an arbitrary evacuation of the intestine and bladder, chaotic movement of arms and legs, sudden tension and muscle relaxation. Pupils almost do not respond to light.
4. Coma of the third degree. Completely disconnected consciousness, reaction to light and pain, reduced pressure, reflexes and temperature, breathing slow, rare, shallow. Man "walks under himself."
5. Coma fourth degree. There is a 100% absence of reaction, reflexes, tone, very low body temperature and pressure, respiration may periodically disappear.

A coma can come in a matter of seconds, minutes or days. Naturally, the slower it develops, the greater the chance of returning the patient to a normal state. That is why it is very important not to delay with hospitalization in case of finding the first signs of comatose state in yourself or your loved one.

Whether the prognosis is favorable, depends on the severity of the coma, as well as on how quickly its primary manifestations were recognized and started to eliminate them. Coma, accompanied by brain damage, with liver failure has poor predictions. It is possible to hope for a favorable outcome in the case of diabetic, alcoholic and hypoglycemic coma, although only if adequate timely therapy has been performed.

If it is an epileptic coma, then treatment is not necessary. The person will regain consciousness after the pathogenic factors stop affecting him.

It should be remembered that even being in a coma for only a few days does not pass without a trace and can negatively affect the physical and mental state.