Comatose states

Coma states occur with significant shifts in the homeostasis system, which is most often caused by severe damage to internal organs.

The most frequently observed are: uremic, hepatic, diabetic (ketoacidotic, hypoglycemic) coma, coma due to traumatic brain injury (TBI) and alcoholic coma.

• Uremic coma occurs as a result of terminal renal failure due to impaired excretion of primarily nitrogenous waste products from the body. Coma develops gradually against the background of other signs (anemia, hyperkalemia, acidosis) of advanced renal damage in the final stage of chronic renal failure, less often it occurs in acute renal failure. Timely use of hemodialysis in these patients prevents the development of a comatose state associated with uremia.
• Hepatic coma occurs with severe liver damage and can develop in a fairly short time. It is usually preceded by mental changes, which doctors often regard as random phenomena reflecting the patient's character traits (nervousness, sleep inversion).
• Diabetic (ketoacidotic) coma can develop quite quickly against the background of satisfactory health, although it is often preceded by severe thirst with the release of large amounts of urine in combination with dry skin, which the patients themselves usually keep silent about.
• Hypoglycemic coma usually occurs in diabetes mellitus as a result of insulin treatment. Although patients with diabetes mellitus are well familiar with the feeling of hunger as a precursor to this condition, coma can still develop suddenly (on the street, in transport). For these cases, each patient should have a "Book of a person suffering from diabetes mellitus" or other medical documentation indicating the dose of insulin administered. One of the clear signs of this coma, which distinguishes it from diabetic coma, is pronounced moisture of the skin.
• Coma due to traumatic brain injury. In these cases, it is often possible to identify external signs of injury or information about it in the anamnesis (hematoma, bleeding from the ear, nose or scrotum, etc.); pupils are sometimes asymmetrical, their reactions to light are slow or absent; the nature of breathing is different (it is often rare or irregular); the pulse is variable (at first frequent, then rare).
• When an unconscious person is found, it is necessary to keep in mind an alcoholic coma. It develops when the concentration of ethanol in the blood is 0.3-0.7 mg%; the smell of alcohol from the mouth is characteristic (nevertheless, it is necessary to exclude a traumatic brain injury in a state of intoxication.

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