Coma induced by intoxication.
Clinicians in the emergency department are often confronted with coma patients due to poisoning. A systematic general approach involving early consultation with a neurologist is of paramount importance. A high index of suspicion, a systematic first assessment already in the prehospital phase and early stabilisation of vital functions are the essential first steps. Specific antidotes like hypertonic glucose and thiamine are part of a "coma cocktail". The opiate antagonist naloxone should be used only when clinically indicated and in a titrated way. Flumazenil should only be used with caution and in restricted cases. Clinical neurological evaluation and technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. Toxicological tests deserve their place in the diagnostic work up of a coma patient with suspected poisoning. Knowledge of the possibilities of the toxicology lab and optimal communication with the clinical toxicologist is important for optimal patient care.
Department of Emergency Medicine, University Hospital, Gent, Belgium.
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Buylaert
D000058:Accidental Falls; D020268:Alcohol-Induced Disorders, Nervous System / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D000435:Alcoholic Intoxication / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000931:Antidotes / Q000627:therapeutic use; D001930:Brain Injuries / Q000175:diagnosis; D003128:Coma / Q000139:chemically induced* / Q000628:therapy; D003926:Diabetic Coma / Q000175:diagnosis; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D062787:Drug Overdose / Q000175:diagnosis; D004630:Emergencies; D000431:Ethanol / Q000506:poisoning*; D005392:First Aid; D005442:Flumazenil / Q000627:therapeutic use; D005934:Glucagon / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D002534:Hypoxia, Brain / Q000209:etiology / Q000517:prevention & control; D008991:Monitoring, Physiologic; D009270:Naloxone / Q000627:therapeutic use; D009460:Neurologic Examination; D020521:Stroke / Q000175:diagnosis; D013831:Thiamine / Q000627:therapeutic use
D000931:Antidotes; D009270:Naloxone; D000431:Ethanol; D005442:Flumazenil; D005934:Glucagon; D005947:Glucose; D013831:Thiamine