Alcoholic coma

Coma is one of the most difficult conditions, which has not been thoroughly studied to the present day. Now it is not known what exactly a person feels when falling into a coma, and that can affect its duration.

Abuse of alcohol can lead to such grave consequences as an alcoholic coma.

Toxic dose for the body is considered to be 300-500ml of alcohol in the blood (depending on the individual characteristics of the organism), if the alcohol concentration reaches 1600ml, severe intoxication begins (vomiting, abdominal pain, loss of consciousness), if exceeds 1800ml - coma develops (blue skin , temperature reduction, noisy breathing).

[1], [2]

Causes of the alcohol coma

Alcoholic coma is the body's response to excessive amounts of alcohol in the blood, in other words, the more a person drank, the greater the risk of severe intoxication and coma development.

Determine the lethal dose of alcohol is almost impossible, in the first place it depends on the characteristics of the body (in some people intoxication begins after several doses, the body of others on the contrary, very resistant to alcohol).

Also important is the general state of human health - immunity, liver condition or other diseases. Also, drinking alcohol on an empty stomach leads to more intoxication and can cause alcoholic coma.

[3], [4], [5]

Pathogenesis

Alcoholic coma can develop within a few hours. Increase the risk of this condition excessive consumption of strong alcohol, especially drunk on an empty stomach.

Alcohol disrupts metabolic processes between brain cells, prevents the entry of oxygen and leads to hypoxia of the brain. This process leads to a decrease in temperature, blood pressure, loss of consciousness, increased heart rate, which along with oxygen starvation provokes swelling of the brain, which becomes the cause of coma.

[6],

Symptoms of the alcohol coma

When you abuse alcohol, the body can react with a complete "cut-off" (loss of consciousness), but often this state is not perceived by others as not serious and often a person simply keeps "sleeping".

But loss of consciousness after drinking alcohol can be the beginning of serious disorders in the body, in particular, in the brain.

Doctors say that alcoholic coma is very easy to confuse with stroke, in addition, the coma may be caused by head injuries.

Physicians distinguish three degrees of alcohol coma:

• 1 degree (superficial coma) - characterized by loss of consciousness, severe vomiting, drooling, hypertension of the limbs, facial skin acquires a blue tint, reflexes are preserved.
• 2 degrees - there is a sharp decrease in pressure, slowing down the breathing, the pulse is hardly probable (the rapid rhythm is noted), the reflexes disappear, but the reaction to pain persists, to this extent the symptom is the involuntary excrement or urination.
• 3 degree (deep coma alcoholic coma) - a rare pulse, weak non-rhythmical breathing, the reaction to pain disappears, the reflexes disappear, the pupils are dilated, the skin becomes a pronounced bluish tinge. In case of not providing adequate medical care, a lethal outcome is possible, most often the cause of death is suffocation by own vomiting or sunken tongue due to loss of muscle tone. With a high concentration of alcohol in the blood, respiratory arrest or cardiovascular failure may occur.

[7], [8], [9]

First signs

Alcoholic coma is characterized primarily by loss of consciousness, drooling, blue skin, most often face and hands.

Complications and consequences

Alcoholic coma can last on average from 7 to 20 days, in rare cases in such a condition a person can spend years.

Recovery is gradual - in the beginning consciousness returns for several hours, with time a person holds in consciousness more and more.

In the body, during a period of being in a coma, a number of changes occur and the consequences largely depend on how much the organism coped with such a load, and also on the degree of coma.

During the coma, the brain is damaged, and this can lead to the fact that after leaving the coma, a number of important functions (ability to walk, talk, move, etc.) will disappear.

After a coma of the 1st degree, recovery occurs more quickly, after the 3rd degree the brain is destroyed almost completely, so in this case the predictions are not comforting.

The most common problems after a person leaves the coma are loss of memory, poor attention, changes in behavior (aggressive state, inhibition, etc.), in some cases relatives and friends stop recognizing the person.

After a coma, a prolonged recovery of household habits takes place (self-washing, eating, etc.).

After a coma, a person may have a desire to do something, but loads, especially severe ones, can significantly worsen the state of health.

Close people should be prepared for the fact that the recovery period will require a lot of effort, the patient needs gymnastics, maintaining personal hygiene, adequate nutrition and sleep, walking outdoors, regular visits to a doctor, taking medicines.

Complications

Alcoholic coma leads to a number of disorders in the body, which can manifest as separate diseases.

First of all, the functioning of the limbs as a result of puffiness is disturbed, sensitivity and coordination of movements are limited (such disturbances can disturb quite a long time).

During the coma there is accumulation of toxins, myoglobin, protein in the urine, kidney failure develops, this leads to the fact that after a coma the urine becomes bloody, brownish-black.

Intoxication with alcohol leads to an increase in the level of urea, nitrogen in the blood.

Also, a coma will burn to lead to muscular atrophy, excessive potassium in the body, bleeding of the skin or mucous membranes.

If there is severe intoxication of the body against a background of kidney failure, the probability of a lethal outcome increases several times.

[10], [11], [12], [13]

Diagnostics of the alcohol coma

Diagnosis is based on the basic syndrome - coma. Information on the circumstances of poisoning is often insufficient or it is unreliable.

Alcoholic coma is supposed by symptoms and characteristic smell of alcohol from the patient (in the exhaled air or the contents of the stomach).

During the diagnosis, it is important for a specialist to take into account the possibility of combining alcohol and other types of coma: neurological (head injuries, circulatory disorders in the brain), somatic (for acute hepatitis, diabetes, etc.), toxic (use of alcohol along with narcotic substances, drugs , technical fluids, etc.).

The intake of alcohol often provokes a malfunction of the liver and kidneys, pancreatitis, diabetic coma.

To identify other possible types of coma, a thorough examination of organs and systems is performed using ultrasound, X-ray, and other methods.

Neurological status is also determined (consciousness, pupils, nausea or vomiting, evaluation of muscle strength, pain sensitivity, convulsions, reflexes, etc.), echoencephaloscopy or lumbar puncture may be prescribed for examination.

[14], [15], [16], [17],

Analyzes

If an alcoholic coma is suspected, the doctor prescribes a general analysis of blood and urine, biochemical studies (glucose level, amylase, blood coagulation test, protein metabolism, etc. If necessary).

To determine the severity of the consequences and the depth of the lesion, an analysis is made for the level of alcohol in the blood.

If there is no positive effect of treatment after several hours, it is possible that the coma is caused by toxic poisoning (simultaneous reception of medicines, drugs, technical fluids, etc.) and the tactics of treatment should be changed.

[18], [19], [20]

Instrumental diagnostics

In alcohol coma, various methods of instrumental diagnostics, in particular ultrasound (for assessing the condition of internal organs - the pancreas, liver, kidneys, etc.) can be prescribed.

Echoencephaloscopy (more often with head injuries) can also be prescribed, which is based on the echolocation of the sagittal brain structures. Diagnosis helps to identify intracranial pathology, the technique is carried out using sensors that are applied to the side of the head and output information to an external computer.

In unclear cases, spinal (lumbar) puncture is prescribed (with suspicion of nervous or mental illness, head or back injuries, vascular diseases).

Differential diagnosis

Differential diagnosis is carried out mainly if alcohol was mixed with drugs, narcotic substances and other toxins.

If there are signs of circulatory disorders in the brain, alcohol coma is diagnosed much harder. In such situations, specialists compare the changing neurological data, prescribe laboratory tests, and on the basis of this choose the treatment tactic (it should be noted that in this case, the high risk of death).

With head injuries and circulatory disturbances, a gradual deepening of the coma is observed in the brain, an increase in muscle tone, abnormal flexion or extension of the fingers on only one leg, in addition, the patient may be unequally dilated (narrowed) pupils in the eyes.

Treatment of the alcohol coma

If there is a suspicion of an alcoholic coma, mandatory admission to special toxicology departments is necessary, where intensive therapy will be carried out.

The principle of treatment is based on blocking the further absorption of alcohol into the blood, for these purposes, urgent rinsing of the stomach is prescribed using a probe. The procedure is carried out by inserting the tube into the larynx, which allows to avoid penetration of the respiratory tract fluid and vomiting. Rinse with clean water at room temperature.

To accelerate the process of excretion of alcohol from the blood, administration of a solution of glucose and insulin (20 units of insulin and 0.5 liters of glucose solution 20%), anti-shock (polyglucin, polyvinol), 0.5 ml of physiological solution (for replenishing fluid during dehydration) is administered intravenously.

Intramuscularly prescribed vitamin B6 and B1 (5-6ml,), nicotinic acid (1%, 5ml).

If acid-base balance is disturbed, which is observed in comatose conditions, sodium bicarbonate 4% (intravenously, up to 1000 ml) is prescribed.

Such therapy allows you to get a person out of a coma in a few hours.

Alcoholic coma causes disruption of the thermoregulatory center in the hypothalamus, which leads to supercooling, in this case the rinsing is done by warm water (up to 370С), intravenous solutions are heated to 37-380С, the patient is surrounded by heaters.

If breathing is disturbed, the oral cavity is cleared, a special tube inserted into the trachea (intubation), and the contents drained from the upper respiratory tract. In case of severe breathing, it is necessary to connect an artificial respiration device, to prevent aspiration pneumonia, which develops against the background of vomiting into the lungs, antibacterial therapy is prescribed.

To restore the normal operation of the cardiovascular system, intravenous administration of plasma-replaceable fluids 500-1000 ml (polyvinol, polyglucin, plasma, hemodez, gelatin) is prescribed, after which physiological saline is prescribed to compensate for fluid loss. At the same time, the introduction of drugs for the heart and blood vessels is shown:

• cordiamine 5-10ml
• strofantine 0.05% 0.5ml
• ephedrine 5%, 5-8ml

With a sharp decrease in pressure, prednisolone 60-90 mg is administered.

All medical procedures are carried out under the control of the water-salt balance, the amount of injected fluid is determined taking into account the daily urine production.

If the patient has signs of muscle damage, drip 4% (from 1500 to 2000 ml per day), a mixture of glucose 10% and novocain 2%, antibacterial and hormonal preparations, vitamin C, B vitamins, and preparations for heart support are prescribed.

To prevent violations of the kidneys, a two-sided Novocaine lumbar blockade is prescribed (copious administration of Novocaine to the surrounding nerve endings), paraffin applications on the lower back.

With a low acidity of urine, it is necessary to enrich the body with alkali, which helps prevent severe disruption of kidney function. For this purpose, extrarenal blood purification is administered by artificial means.

If the patient entered a small medical facility where there is no possibility to conduct the whole complex of necessary medical procedures, the main attention is paid to the prevention of respiratory system disorders (for this the patient should be in a position where the head is below the legs), the tongue is fixed with a special clamp, the oral cavity is thoroughly cleaned, under the skin Atropine is administered 0.1% (2 ml).

After this, the stomach is washed with the help of the probe (in this case the patient should remain in the upside down position).

Urgent care

To first aid for alcohol coma is gastric lavage with a probe and intravenous sodium bicarbonate, glucose, insulin.

Medications

Alcoholic coma is a serious condition that requires a number of medical procedures.

Drug therapy is aimed at eliminating the intoxication of the body with alcohol, replenishing the water-salt balance, normalizing the work of all organs and systems.

Glucose with intravenous injection contributes to an increase in osmotic blood pressure, increases fluid flow into the blood from the tissues, improves metabolic processes in the body and antitoxic liver function, increases the contraction of the heart muscle, dilates the vessels, increases the excretion of urine.

Insulin affects carbohydrate metabolism in the body, lowers blood glucose levels, improves its penetration into cells, blocks the conversion of fats and amino acids into carbohydrates.

Plasma and anti-shock drugs:

• Polyglukin is prescribed for the prevention of acute blood loss, with severe intoxication. The main substance of the drug - dextran - promotes replenishment of blood volume, prevents the adhesion of red blood cells and platelets.
• Polyvinol is used for intoxication and bacterial shock. The drug has an effective detoxification effect, is removed from the body in a short time, while it absorbs and removes toxins.
• Reopoliglyukin (analog of polyglucin), has a disaggregating effect (reduces the risk of thrombosis), is prescribed in severe shock conditions to preserve the functions of vital organs. Contraindicated in heart failure, a decrease in the amount of urine secreted by the kidneys, a decrease in the level of platelets.
• Hemodez neutralizes foreign substances (including a number of drugs), toxins of pathogenic microorganisms, etc., absorbing them from the blood, reduces the risk of blood clots, eliminates the stopping of red blood cells in the capillaries, increases blood circulation. Contraindicated in bronchial asthma, acute nephritis, hemorrhages in the brain.
• Gelatinol has a weaker effect in comparison with polyglucin, but it effectively stabilizes the movement of blood through the vessels. The drug is non-toxic, does not lead to an increase in sensitivity, does not accumulate in the body, does not change the structure of red blood cells and the composition of blood.

It is not prescribed for acute kidney pathologies.

In large doses (up to 3 liters) prevents normal protein metabolism, leads to a decrease in the osmotic pressure in the intercellular space, increases the risk of tissue hypoxia.

Cardiovascular drugs:

• Ephedrine stimulates the work of the heart, increases the strength and frequency of contractions, raises blood pressure, increases the tone of skeletal muscles, increases the sugar content in the blood serum. Contraindicated with high arterial pressure, tachycardia, myocardial disease, tumors that release catecholamines.
• Cordiamin - an analeptic, stimulates the work of the central nervous system, stimulates the vasomotor and respiratory centers, stimulates the work of the heart. By the mechanism of action is close to camphor, caffeine, corazole. Contraindicated in epilepsy, convulsions.
• Strofantin (cardiac glycoside short-acting) increases the strength and frequency of contractions of the myocardium, which causes an increase in the shock and minute volume of blood, reduces the need for myocardium in oxygen.
• Prednisolone increases the level of glucose in the blood, increases the back absorption of water and sodium, has a pronounced anti-inflammatory effect. Contraindicated with hypersensitivity to the drug, fungal infections.

Alternative treatment

Alcoholic coma is a serious condition, which requires urgent hospitalization of the patient. Treatment of this condition with alternative medicine is practiced, but some recipes of alternative healers will help the body to recover faster after a coma.

Rose hips softly clean the liver and blood.

Cabbage juice reduces pain in the liver, replenishes the lack of vitamins in the body.

Berries cranberries, currants are often recommended to use with any intoxication, they contain a large number of vitamins and trace elements that are necessary for normal liver function.

Cranberries, despite the skepticism of traditional medicine, have long been used in the people for the treatment of liver diseases, it is recommended before eating to eat 1ch.l. Cranberries, grated with honey, to normalize the liver and improve the body.

The juice of black radish and honey contributes to mild liver cleansing (0.5 liters of juice and 200ml of honey, 2 tablespoons of 2 times a day).

Citrus juices help the liver cells recover, they contain many vitamins, especially vitamin C, which helps the liver remove toxins.

[21], [22], [23], [24]

Herbal Treatment

Among the herbs are most suitable for the restoration of the liver after alcohol intoxication immortelle, artichoke, spores, milk thistle, St. John's wort.

Herbal treatment is mainly carried out after the person leaves the coma to restore the functions of internal organs, improve the overall health, replenish vitamins.

Alcoholic coma leads to disruption of a number of vital functions of the body, especially severe effects are observed in the CNS.

Collection of medicinal herbs, after alcohol intoxication:

1. Buds of birch, St. John's wort, immortelle, chamomile - 100g. 1 tbsp. Mixture of herbs pour 0.5 liters of boiling water, insist 15 minutes, drain. Half of the infusion obtained before going to bed (you can put 1 hl honey), the second part in the morning. The course of treatment at least a month. Infusion helps to improve metabolism, clean blood vessels, remove toxins, improve vision, and normalize weight.
2. Mint leaves, immortelle (3 tablespoons), dill seed (1 st.l.). 1t.l. Mixture pour 400-500ml boiling water, insist for half an hour, drink warm for half an hour before eating. The course of treatment is 2 months.

Homeopathy

Homeopathy is considered an unconventional method of treating dependence on alcohol.

Alcoholic coma is a condition that is caused by poisoning the body with ethyl alcohol, homeopathic drugs will help reduce craving for alcohol and prevent the onset of such severe consequences as alcohol intoxication or coma.

The most famous remedy among homeopaths, helping to overcome a painful attraction to alcohol, is Proproten 100, which contains extremely low doses of antibodies to the protein, which is the main regulator of brain nerve activity. The drug is effective for mild and moderate severity of alcohol dependence, it acts on the main areas of the brain, normalizes its functions, helps to reduce excitability, anxiety, to remove mental overstrain, painful cravings for alcoholic beverages. Also, the drug eliminates headaches, weakness, improves the work of the digestive system and removes other symptoms characteristic of the "hangover" syndrome.

Take the drug should be no earlier than 6 hours after the last intake of alcohol, 20 minutes before meals.

In the first two hours from the beginning of the intake, you need to drink 5-10 drops or dissolve 1 tablet every half hour, then every hour.

After about 10 hours, when the patient's condition improves, the drug is taken every 2-3 hours (per day, 4-6 tablets).

Taking the drug can cause short-term double vision in the eyes, which does not require additional treatment. In rare cases, allergic reactions occur.

Proproten 100 should be taken with caution taken with sleeping pills.

Before the reception is necessary to consult a narcologist.

Operative treatment

Alcoholic coma is associated with poisoning the body with ethyl alcohol and the basis of treatment is the elimination of alcohol from the body with the help of gastric lavage, which must be done only in a medical institution with a probe.

Operative treatment patients in alcoholic coma are not subject.

Prevention

Alcoholic coma is a consequence of poisoning the body with ethyl alcohol to prevent this condition, you do not need to drink any alcoholic drinks on an empty stomach (the absorption of blood in this case is several times higher), do not drink large doses of alcohol, do not drink with any gastrointestinal diseases, during dietary nutrition, with overwork.

It is also contraindicated the use of alcohol simultaneously with any medications.

It is not recommended to mix different alcoholic beverages (or use ascending degrees), and also eat well after each dose of alcohol.

The best prevention of alcohol poisoning and other severe consequences associated with drinking alcohol is the total rejection of alcohol.

[25]

Forecast

When providing timely medical assistance, the likelihood of a favorable prognosis in a condition such as an alcoholic coma is quite high.

If the victim is sent in time to the hospital, where he received competent help, the state of health comes in a few hours.

If a person is in a coma for more than a day, the chances of a positive outcome are significantly reduced, especially if there are severe symptoms (low blood pressure for a long time, arrhythmia, uneven breathing, etc.).

Alcoholic coma is a serious condition caused by poisoning with ethyl alcohol. This condition is often the outcome with prolonged use of alcohol in large doses, when the body ceases to cope with toxins and simply "turns off".

The condition is quite severe and can lead to death or disability, but timely competent help of doctors will help to return a person to a full life. After leaving the coma, people need the help of close people, as well as specialized help, to cope with the painful cravings for alcohol and return to normal life.

[26]