ICD code: coma of unknown etiology. R41 Other symptoms and signs related to cognition and awareness. R36 Discharge from the urethra

Diseases of this organ can provoke a serious condition - hepatic coma. It has several stages, can be caused by various reasons and lead to serious consequences, including death. Our article will tell you more about this disease.

Definition and code according to ICD-10

The regulatory document defining the international classification of medical diagnoses ICD-10 regulates the following liver diseases.

ICD code – 10:

• K 72 - , not classified elsewhere.
• By 72.0 - acute and subacute liver failure.
• K 72.1 - chronic liver failure.
• K 72.9 - liver failure unaccounted for.

The disease develops against the background of general intoxication of the body. Phenol, ammonia, sulfur-containing amino acids and low molecular weight fatty acids accumulate in the body. They have a toxic effect on the brain, which increases when the water-electrolyte balance is disturbed.

Forms

Liver dysfunction can be of various types. In total, three variants of hepatic coma have been identified, which can lead to serious consequences.

What types of coma are there:

• Endogenous, in which disorders can be caused by viral forms of hepatitis, dystrophic and destructive processes in the organ during cirrhosis, as well as replacement of healthy liver tissue with a tumor or scars. It is very painful and progresses quickly, with pain felt in the area of ​​the affected organ, hemorrhoidal disorders, jaundice and itching of the skin and a severe “liver” odor from the mouth. Psychosomatic disorders often manifest themselves, periods of increased activity alternate with complete loss of strength, depression and excessive fatigue.
• Exogenous hepatic coma occurs more often with chronic organ dysfunction, cirrhosis and chronic renal failure. This form of disease lacks a characteristic odor and psychosomatic signs. The disease is relatively painless and without pronounced symptoms. The problem can be identified by identifying portal vein hypertension.
• Mixed forms are characterized by symptoms of endogenous and exogenous forms of hepatic coma. At the same time, along with necrotic processes in organ tissue, problems of hematopoietic function are diagnosed, and symptoms may include various manifestations of previous forms of the disease.

Stages of the disease

Depending on the severity of the patient’s condition, there are three stages of this disease. In this case, the central nervous system is affected, brain function is disrupted, and accompanying symptoms are observed.

The disease has the following stages:

1. Precursor or antecedent phase. The patient is emotionally unstable, mood swings are very abrupt and do not depend on external influences. Aggression and sleep disturbances (drowsiness during the day, insomnia at night) may occur. It is difficult to concentrate on any issue, consciousness is clouded, mental activity is inhibited. Frequent symptoms: tremors of the limbs, severe headache, nausea, vomiting, hiccups, excessive sweating, dizziness.
2. Excitement phase or threatening coma. Strong emotional upsurge, aggressiveness, anxiety. Mental activity is practically absent, movements are mechanical and without a specific purpose. Disorientation in time and surroundings often occurs. Pain sensations are dull, reactions only to external stimuli.
3. Complete or deep coma. Complete absence of consciousness, emotions and reactions to stimuli. The breathing rate may change (up to a complete stop), blood circulation slows down. The blood pressure level is reduced, sphincter paralysis occurs, and corneal reflexes go out.

Causes

Hepatic coma develops against the background of existing chronic diseases and pathologies of the liver, as well as due to toxic effects.

The main reasons are:

• Viral hepatitis of groups A, B, C, D, E, G.
• Viral liver diseases, including herpes, infectious mononucleosis, Coxsackie's disease, measles,.
• Vasiliev-Weil disease (icteric leptospirosis).
• Liver damage due to fungal or microplasma infection.
• Severe intoxication with toxic substances.

Threatening factors include the use of alcohol and psychotropic substances, the inclusion in the diet of excessive amounts of protein foods, as well as wild mushrooms.

Pathogenesis

The processes of pathogenesis have not been fully studied. It is known that in this condition the functioning of neurotransmitter systems is disrupted, and an excess of breakdown products (nitrogen compounds, fatty acids and neurotransmitters) negatively affects the functioning of the brain and central nervous system.

Symptoms

Depending on the causes and severity of the disorders, the symptoms of the disease may vary. It is also worth taking into account the individual characteristics of the patient, which also determine the severity of the lesion and the prognosis of treatment.

The main symptoms are:

1. Feelings of anxiety, thinking disorders.
2. Problems sleeping at night, sleepiness during the day.
3. Muscle cramps and increased tone.
4. Yellowing of the skin.
5. Accumulation of fluid in the abdominal cavity (ascites).
6. Bleeding, the appearance of hematomas.
7. Soreness in the liver area.
8. Increased body temperature, chills and fever.
9. Tachycardia, decreased blood pressure.
10. Tremor of the extremities, usually the fingers.

In various stages, there may be increased mental agitation, aggression and sudden mood changes. In addition, evidence of problems in the liver can be a strong bad breath, digestive disorders (prolonged vomiting, constipation or diarrhea), paralysis of the sphincters.

Complications

Progressive liver failure affects the general condition of the patient, threatening his life. This disease has no complications as such, because hepatic coma in itself is a very serious condition, leading to irreversible processes in the body.

Diagnostics

The disease is determined by.

These include bilirubinemia (increased concentration of bile pigment), azotemia (exceeding normal levels of nitrogenous products), decreased levels of prothrombin, cholesterol and glucose.

Urine becomes richly yellow in color, bile acids and urobilin can be found in it, feces become discolored.

Urgent Care

If a sharp deterioration in health occurs outside the walls of a medical institution, the patient must be placed on his side, ensuring normal air flow, and an ambulance must be urgently called.

Before the doctors arrive, you should not change position, shake or move the patient. Such conditions require immediate hospitalization, and already in the hospital an active struggle for the patient’s life begins.

What can be done in the hospital:

• Administer a glucose solution with panangin to improve brain activity.
• A complex of saline and insulin for severe catatonic conditions.
• On the first day, an increased dose of prednisolone is prescribed to relieve the toxic effect on the organ.
• Stimulation of liver activity is carried out using an intravenous or intramuscular solution of nicotinic acid, riboflavin, thiamine chloride and pyridoxine.

First aid consists of reducing symptoms of intoxication, stabilizing respiratory function, water and electrolyte balance and protein metabolism. Until the condition is stabilized and in order to prevent a deep coma, the patient is in the intensive care unit.

Treatment

Further treatment measures are agreed upon with the attending physician. The prognosis and chances of recovery depend on many factors, including the presence of concomitant diseases, age and the degree of organ damage.

The following methods are commonly used:

1. Diet and limiting the amount of protein consumed.
2. Taking antibacterial agents that reduce the activity of intestinal flora and the formation of waste products.
3. Maintenance therapy consists of using glucose solution, saline solution, and glucocorticoids.
4. To reduce ammonia levels, you need to take glutamic acid and arginine.
5. Excessive psychosomatic symptoms are corrected with special antipsychotics.
6. In case of dysfunction of the respiratory system, the patient is connected to an oxygen mask.

If a diagnosis of toxic poisoning is made, all measures should be aimed at detoxifying the body. The doctor may suggest a blood transfusion, as well as hemodialysis, if kidney failure is added to the main symptoms.

How long does hepatic coma last?

Even the most highly qualified doctor will not be able to give accurate forecasts. It will be extremely difficult to bring a patient out of a complete coma, so it is best to seek help in the early stages of the disease.

The recovery rate is significantly influenced by accurate diagnosis and elimination of the cause, but in more than 15% of cases it cannot be determined.

Prognosis and prevention

The chances of recovery in patients who have suffered a hepatic coma are extremely low.

Basically, this is no more than 20% of survivors at the precoma stage, less than 10% in the threatening phase and approximately 1% in a deep coma. Even such disappointing forecasts are not always possible, and only with timely and competent treatment.

Irreversible processes that occur in the body under the influence of decay products, as well as suppression of functions or complete failure of an organ, affect the activity of the central nervous system and brain.

It is extremely difficult to bring a person out of a deep coma, and the most successful treatment method at the moment is a donor liver transplant and long-term drug therapy.

There are no preventive measures against this disease. To maintain the health of this organ, it is necessary to follow general recommendations: refuse and take, maintain moderation in diet, and also regularly subject the body to feasible physical activity.

All problems and identified diseases must be treated in time and regularly examined if possible. Hepatic coma, regardless of its forms and stages, causes irreparable harm to health and significantly reduces the quality and life expectancy, so its symptoms should never be ignored.

Occasion:“Unconscious, was healthy, loss of consciousness, patient has limited mobility”
Male, 73.

Diagnosis: "Coma of unknown etiology (hepatic?); clinical death; resuscitation measures; biological death; death declaration."

Complaints:
When the EMS team arrives, a man is lying on the bed, unconscious; chest excursion is visualized with a respiratory rate of 14-16 per minute.

Anamnesis:
According to the son, he was discovered in this state at approximately 3 o'clock in the morning, having decided that the patient was sleeping - they did not attach much importance to this. At 3:30 a.m., the relatives called a urologist at 03 to replace the cystostomy tube, which had become clogged the night before; the dispatcher warned about the long wait for the doctor. At 5:55 a.m. they realized that the patient’s condition was critical and called brigade 03 on the grounds of “unconsciousness.”
History: IHD, NK2B, hypertension stage 3, chronic alcoholism, chronic viral hepatitis C, liver cirrhosis of combined etiology in the subcompensation stage, portal hypertension - hepatosplenomegaly, hepatic cell failure; chronic anemia of moderate severity, chronic calculous cholecystitis, chronic urinary retention, cystostomy from 2009.
The patient is being observed. therapist. Doesn't take medications regularly. Varicose veins of the lower extremities. Allergy epidemiology is calm. Date of last inpatient treatment: 2013.

Objectively:
The general condition is serious, coma. On the Glasgow scale 3-4 points. The position is passive. The skin is dry and of normal color. There is no rash, the throat is clean and pink. The tonsils are not enlarged. Lymph nodes are not enlarged. There are no bedsores. Pastosity of the lower extremities. Temperature 36.2.
NPV 14-16. There is no shortness of breath or pathological breathing. Auscultation is weakened in all parts. The rales are moist, medium-bubbly in all parts of the lungs. There is no crepitus. Percussion sound no data, not determined. Cough, sputum - no data.
Pulse 70. Rhythmic, weak filling. Heart rate 70. There is no pulse deficit. BP=100/70. The usual 140/80. Maximum no data, unknown. Heart sounds are muffled. There is no accent, no noise.
The tongue is dry and clean. The abdomen is swollen, soft, not tense, painlessness is not determined. Surgical symptoms are uninformative. Peristalsis is not heard. Liver +1-2 cm, spleen not palpable. No vomiting. Chair - no data.
No contact possible. There is no sensitivity. There is no speech. Pupils D=S, normal. The photoreaction is sluggish. Nystagmus - no data. There is no facial asymmetry. Meningeal symptoms are not informative. There are no focal symptoms. Does not perform coordination tests. Urination - cystostomy. Symptom of effleurage - no data.

Additional examination methods:
Glucometry 4.8
O2 saturation=86%
ECP - sinus rhythm, heart rate 70, EOS to the left. Nonspecific ST-T changes, AV block 1st degree.

Therapy:
6 hours 12 minutes: catheterization of the cubital vein.
O2 inhalation 100% V=10 l/min.
6 hours 15 minutes: placement of the laryngeal tube, O2 inhalation 100% V=10 l/min.
The patient maintained spontaneous breathing, RR=14/min.
6 hours 18 minutes: transfer of ECP, call of a special team.
6 hours 22 minutes: clinical death, circulatory arrest, asystole.
6 hours 24 minutes: start of resuscitation measures:
indirect cardiac massage 30:2,
while transferring the patient to the floor - accidental extubation of the laryngeal tube,
ongoing NMS 30:2,
tracheal intubation with an endotracheal tube - successful,
transfer of the patient to mechanical ventilation 100% O2, MOV=10 l/min., RR=10/min.
indirect cardiac massage 30:2,
IV administration Sol. Adrenalini hydrochloridi 0.1%-1 ml. every 5 min.
7 h 05 min: resuscitation measures are ineffective, cessation of resuscitation measures,
7 hours 06 minutes: declaration of death.

Coma- unconsciousness caused by dysfunction of the brain stem.

Code according to the international classification of diseases ICD-10:

• R40.2

Causes

Etiology: traumatic brain injury, stroke, infection, status epilepticus, brain tumors, exogenous intoxications, systemic metabolic disorders (diabetes mellitus, hypoglycemia, uremia, eclampsia, thyrotoxicosis), etc. A decisive role in the development of coma is played by damage to the ascending activating systems of the brain stem and interstitial brain.

Symptoms, course. Depending on the severity of impairment of vital functions, coma is divided into several degrees. In mild coma, patients respond to painful stimuli; reflexes from the nasal mucosa, corneal and pupillary, are preserved; sometimes tendon reflexes persist and Babinski's sign is caused. Severe degree of coma: reaction only to intense painful stimuli, swallowing is impaired, but when food enters the respiratory tract, a reflex cough occurs; stertorous breathing, often of the Cheyne-Stokes type. Deep coma: areflexia, atony, mydriasis, severe respiratory and circulatory disorders. Transcendental (terminal) coma: the patient’s vital activity is maintained only through artificial ventilation of the lungs and stimulation of the heart.

Treatment

Treatment. When establishing the nature of coma, pathogenetic therapy is used. At all stages of coma - resuscitation measures.

Forecast depends on the cause of the coma and the severity of the brainstem damage. In deep coma, the prognosis is often unfavorable; absolutely unfavorable prognosis for extreme coma.

Diagnosis code according to ICD-10. R40.2

ICD 10. CLASS XVIII. SYMPTOMS, SIGNS AND DEVIATIONS FROM THE NORM, IDENTIFIED DURING CLINICAL AND LABORATORY STUDIES, NOT CLASSIFIED OTHERWISE (R20-R49)

SYMPTOMS AND SIGNS RELATING TO THE SKIN AND SUBcutaneous Tissue (R20-R23)

R20 Skin sensitivity disorder

Excluded: dissociative anesthesia and sensory loss
perception ( F44.6)
psychogenic disorders ( F45.8)

R20.0 Skin anesthesia
R20.1 Skin hypoesthesia
R20.2 Skin paresthesia. "Crawling" sensation. "pins and needles" sensation
Excludes: acroparesthesia ( I73.8)
R20.3 Hyperesthesia
R20.8 Other and unspecified skin sensitivity disorders

R21 Rash and other nonspecific skin eruptions

R22 Localized bulging, induration or swelling of the skin and subcutaneous tissue

Includes: subcutaneous nodules (localized) (superficial)
Excluded: deviations from the norm detected upon receipt
diagnostic image ( R90-R93)
enlarged lymph nodes ( R59. -)
localized fat deposition ( E65)
hardness or swelling:
mammary gland ( N63)
intra-abdominal or pelvic ( R19.0)
swelling ( R60. -)
intra-abdominal or pelvic bulge ( R19.0)
swelling of the joints ( M25.4)

R22.0 Localized bulging, induration, or swelling in the scalp
R22.1 Localized bulging, induration, or swelling in the neck area
R22.2 Localized bulging, induration, or swelling in the torso area
R22.3 Localized bulging, induration, or swelling of the upper limb
R22.4 Localized bulging, induration, or swelling in the lower extremity
R22.7 Localized bulging, hardening, or swelling of multiple areas of the body
R22.9 Localized bulging, induration, or swelling, unspecified

R23 Other skin changes

R23.0 Cyanosis
Excluded: acrocyanosis ( I73.8)
attack of cyanosis in a newborn ( P28.2)
R23.1 Pallor. Cold, damp skin
R23.2 Hyperemia. Excessive redness
Excludes: associated with menopause and menopause in women ( N95.1)
R23.3 Spontaneous ecchymoses. Petechiae
Excluded: ecchymosis in the fetus and newborn ( P54.5)
purpura ( D69. -)
R23.4 Changes in skin structure
Peeling)
Seal ) skin
Scaly)
Excludes: epidermal thickening NOS ( L85.9)
R23.8 Other and unspecified skin changes

SYMPTOMS AND SIGNS RELATING TO THE NERVOUS AND MUSCULOSCAL SYSTEMS (R25-R29)

R25 Abnormal involuntary movements

Excluded: specific movement disorders ( G20-G26)
stereotypical movement disorders ( F98.4)
tics ( F95. -)

R25.0 Abnormal head movements
R25.1 Tremor, unspecified
Excludes: chorea NOS ( G25.5)
tremor:
essential ( G25.0)
dissociative ( F44.4)
intentional ( G25.2)
R25.2 Cramp and spasm
Excluded: carpopedal spasm ( R29.0)
baby spasms ( G40.4)
R25.3 Fasciculation. Jerking NOS
R25.8 Other and unspecified abnormal involuntary movements

R26 Gait and mobility disorders

Excluded: ataxia:
NOS ( R27.0)
hereditary ( G11. -)
motor (syphilitic) ( A52.1)
immobility syndrome (paraplegic) ( M62.3)

R26.0 Ataxic gait. Unsteady gait
R26.1 Paralytic gait. Spastic gait
R26.2 Difficulty in walking, not elsewhere classified
R26.8 Other and unspecified gait and mobility disorders. Unsteadiness when walking NOS

R27 Other coordination disorder

Excluded: ataxic gait ( R26.0)
hereditary ataxia ( G11. -)
dizziness NOS ( R42)

R27.0 Ataxia unspecified
R27.8 Other and unspecified coordination disorder

R29 Other symptoms and signs relating to the nervous and musculoskeletal systems

R29.0 Tetany. Carpopedal spasm
Excluded: tetany:
dissociative ( F44.5)
newborn ( P71.3)
parathyroid ( E20.9)
after removal of the thyroid gland ( E89.2)
R29.1 Meningism
R29.2 Abnormal reflex
Excludes: abnormal pupillary reflex ( H57.0)
increased gag reflex ( J39.2)
vasovagal reaction, or fainting ( R55)
R29.3 Abnormal body position
R29.4 Snapping hip
Excludes: congenital hip deformity ( Q65. -)
R29.8 Other and unspecified symptoms and signs related to the nervous and musculoskeletal systems

SYMPTOMS AND SIGNS RELATED TO THE URINARY SYSTEM (R30-R39)

R30 Pain associated with urination

Excludes: psychogenic pain ( F45.3)

R30.0 Dysuria. Difficulty urinating [strangury]
R30.1 Bladder tenesmus
R30.9 Painful urination, unspecified. Painful urination NOS

R31 Nonspecific hematuria

Excludes: recurrent or persistent hematuria ( N02. -)

R32 Urinary incontinence, unspecified

Enuresis NOS
Excluded: enuresis of inorganic nature ( F98.0)
stress-induced urinary incontinence and others
specified urinary incontinence ( N39.3-N39.4)

R33 Urinary retention

R34 Anuria and oliguria

Excluded: cases complicating:
abortion, ectopic or molar pregnancy ( O00 -O07 , O08.4 )
pregnancy, childbirth and the postpartum period ( O26.8, O90.4)

R35 Polyuria

Frequent urination
Nocturnal polyuria [nocturia]
Excludes: psychogenic polyuria ( F45.3)

R36 Discharge from the urethra

Discharge from the male penis

R39 Other symptoms and signs related to the urinary system

R39.0 Extravasation of urine
R39.1 Other difficulties related to urination. Intermittent urination. Weak stream of urine
Split stream of urine
R39.2 Extrarenal uremia. Prerenal uremia
R39.8 Other and unspecified symptoms and signs related to the urinary system

SYMPTOMS AND SIGNS RELATED TO COGNITIVE ABILITY
PERCEPTION, EMOTIONAL STATE AND BEHAVIOR (R40-R46)

Excluded: symptoms and signs that are part of the clinical picture of a mental disorder ( F00-F99)

R40 Doubt, stupor and coma

Excluded: coma:
diabetic ( E10-E14 with a common fourth character.0)
hepatic ( K72. -)
hypoglycemic (non-diabetic) ( E15)
newborn ( P91.5)
uremic ( N19)

R40.0 Doubtfulness [hypersomnia]. Drowsiness
R40.1 Stupor. Prekoma
Excluded: stupor:
catatonic ( F20.2)
depressive ( F31-F33)
dissociative ( F44.2)
manic ( F30.2)
R40.2 Coma unspecified. Unconscious state NOS

R41 Other symptoms and signs related to cognition and awareness

Excludes: dissociative [conversion] disorders ( F44. -)

R41.0 Disorientation, unspecified. Blackout NOS
Excluded: psychogenic disorientation ( F44.8)
R41.1 Anterograde amnesia
R41.2 Retrograde amnesia
R41.3 Other amnesias. Amnesia NOS
Excluded: amnesic syndrome:
caused by the consumption of psychoactive substances
funds ( F10-F19 with a common fourth character.6)
organic ( F04)
transient complete amnesia ( G45.4)
R41.8 Other and unspecified symptoms and signs related to cognition and awareness

R42 Dizziness and loss of stability

"Lightness" of the head
Dizziness NOS
Excluded: syndromes related to dizziness ( H81. -)

R43 Impaired sense of smell and taste

R43.0 Anosmia
R43.1 Parosmia
R43.2 Parageusia
R43.8 Other and unspecified disorders of smell and taste. Combined impairment of smell and taste

R44 Other symptoms and signs relating to general sensations and perceptions

Excluded: disorders of skin sensitivity ( R20. -)

R44.0 Auditory hallucinations
R44.1 Visual hallucinations
R44.2 Other hallucinations
R44.3 Hallucinations, unspecified
R44.8 Other and unspecified symptoms and signs related to general sensations and perceptions

R45 Symptoms and signs related to emotional state

R45.0 Nervousness. Nervous tension
R45.1 Anxiety and agitation
R45.2 A state of anxiety due to failures and misfortunes. Anxious state NOS
R45.3 Demoralization and apathy
R45.4 Irritability and anger
R45.5 Hostility
R45.6 Physical aggressiveness
R45.7 State of emotional shock and stress, unspecified
R45.8 Other symptoms and signs related to emotional state

R46 Symptoms and signs relating to appearance and behavior

R46.0 Very low level of personal hygiene
R46.1 Fancy appearance
R46.2 Strange and inexplicable behavior
R46.3 Excessive activity
R46.4 Lethargy and slow reaction
Excluded: stupor ( R40.1)
R46.5 Suspiciousness and obvious evasiveness
R46.6 Excessive interest and attention to stressful events
R46.7 Verbosity and unnecessary details that make the reason for contact unclear
R46.8 Other symptoms and signs related to appearance and behavior

SYMPTOMS AND SIGNS RELATED TO SPEECH AND VOICE (R47-R49)

R47 Speech disorders not elsewhere classified

Excluded: autism ( F84.0-F84.1)
speech excitedly ( F98.6)
specific developmental disorders of speech and language ( F80. -)
stuttering [stammering] ( F98.5)

R47.0 Dysphasia and aphasia
Excludes: progressive isolated aphasia ( G31.0)
R47.1 Dysarthria and anarthria
R47.8 Other and unspecified speech disorders

R48 Dyslexia and other disorders of recognition and understanding of symbols and signs, not classified elsewhere

Excluded: specific developmental disorders of learning skills ( F81. -)

R48.0 Dyslexia and Alexia
R48.1 Agnosia
R48.2 Apraxia
R48.8 Other and unspecified impairments in the recognition and understanding of symbols and signs. Acalculia. Agraphia

R49 Voice disorders

R49.0 Dysphonia. Hoarseness
R49.1 Aphonia. Loss of voice
R49.2 Open twang and closed twang
R49.8 Other and unspecified voice disorders. Voice change NOS

Stupor (subcoma, in English-language sources “stupor”) is a severe depression of consciousness, in which reflex activity is preserved, but the ability for voluntary activity is lost.

General information

Normally, in a state of wakefulness, a person’s consciousness is clear, and the level of his brain activity corresponds to the situation: during an exam it is higher than during rest. Switching between different modes occurs due to the interaction of both hemispheres of the brain and the ascending reticular activating system (ARS).

With organic or functional damage leading to disruption of their functioning, the central nervous system loses the ability to adequately process sensory signals sent by the organs of hearing, vision, touch, and regulate brain activity depending on current circumstances. A person experiences a decrease in the depth of consciousness. Its three main forms are stupor, stupor and coma.

Stunning is incomplete wakefulness, characterized by drowsiness, incoherence of thoughts and actions. Coma is an extreme degree of depression of the central nervous system, which is accompanied by loss of consciousness and reflex activity, as well as disruption of the most important functions of the body. Stupor is an intermediate state between stunning and coma.

Causes

The main reasons why stupor develops:

• tumors, abscesses and hemorrhages in the brain;
• traumatic brain injuries;
• acute hydrocephalus;
• stroke, especially if the upper parts of the brain stem are affected;
• severe hypertensive crisis;
• vasculitis affecting the central nervous system;
• poisoning with toxic substances (carbon monoxide, methyl alcohol, barbiturates, opiates);
• severe hypothermia;
• heatstroke;
• infectious diseases – encephalitis, meningitis;
• sepsis;
• metabolic problems - ketoacidosis in diabetes, liver failure at the final stage, decreased concentrations of glucose, sodium and other important substances in the blood.

Symptoms

Symptoms of stupor appear along with signs of the underlying disease. Their severity depends on the degree of disturbances in the functioning of the central nervous system.

From the outside, stupor looks like deep sleep: the person does not move, his muscles are completely relaxed. At a sharp sound, he opens his eyes, but immediately closes them. It is possible to bring the patient out of this state only for a short time with the help of painful effects (injections, patting the cheeks). At the same time, he can show resistance in response to actions that are unpleasant for him: withdrawing his arms and legs, fighting back.

A person's sensations in a state of stupor are dulled. He does not answer questions, does not respond to requests and changes in the environment. Tendon reflexes are reduced, as is the reaction of the pupils to light. The functions of breathing, swallowing and the corneal reflex are preserved.

In rare cases, hyperkinetic subcoma occurs. It is characterized by isolated, undirected movements and incoherent muttering. But it is impossible to establish contact with a person.

In addition, stupor may be accompanied by symptoms of damage to certain areas of the brain:

• with intracranial hemorrhage and convulsive seizures and increased tone of the neck muscles are observed;
• if the pyramidal system is damaged - paralysis and paresis.

Diagnostics

Subcoma is diagnosed on the basis of clinical symptoms that are revealed during examination of the patient: his pulse, pressure, tendon and corneal reflexes, muscle tone, reaction to pain, and so on are checked. The information collected during the examination makes it possible to differentiate stupor (stupor) from coma and stunning.

• hidden or obvious traumatic brain injury;
• injection marks;
• the smell of alcohol;
• skin rashes and so on.

In addition, body temperature is measured, the heart is auscultated and the amount of glucose in the blood is determined.

Anamnesis is collected, which includes studying the patient’s medical documents, examining his personal belongings, interviewing relatives and other activities. This allows you to find out if a person has chronic diseases - diabetes, epilepsy, liver failure.

To assess the general condition of the body, the following is carried out:

• blood chemistry;
• toxicological studies of blood and urine;
• electroencephalography;
• MRI (CT) of the brain;
• lumbar puncture (if it is suspected that stupor is caused by an infectious disease).

Treatment

The condition of stupor requires immediate help. Simultaneously with the diagnosis, urgent measures are taken:

• airway patency is ensured;
• respiratory and circulatory functions are normalized - intubation is performed if necessary;
• when the level of glucose in the peripheral blood is low, thiamine and glucose solution are administered;
• if an opiate overdose is suspected, a naloxone injection is given;
• if there are signs of injury, the neck is immobilized using an orthopedic collar.

Subcoma is treated in an intensive care unit, where constant hardware monitoring and support of vital functions is carried out: breathing, cardiac activity, pressure, body temperature, oxygen content in the blood. In addition, a system for intravenous drug administration is being established.

Whether a person emerges from stupor or falls into a coma depends on the specifics of the underlying disease. The goal of therapy is to eliminate the causes of depression of consciousness. As a rule, there is a decrease in blood supply and swelling of the brain tissue. To eliminate them, an infusion of mannitol or glucocorticoids is carried out. This helps prevent the brain from wedging into the natural openings of the skull. Otherwise, neuronal death and irreversible consequences leading to permanent neurological disorders are possible. Stupor caused by infectious diseases requires systemic antibiotic therapy.

Since the condition of stupor can last a long time (up to several months), careful care is required for the patient. In mild subcoma, feeding is done naturally, but with measures taken against aspiration; in severe conditions, food is administered through a tube. In addition, attention is paid to the prevention of bedsores and contractures of the limbs (using passive gymnastics).

Forecast

The likelihood of complete restoration of function after a subcoma depends on the reasons that caused it. The prognosis for stupor as a result of a stroke is determined by its form: with the ischemic type it is favorable, with the hemorrhagic type - death occurs in 75% of cases.

If stupor is the result of poisoning or reversible metabolic disorders, then the possibility of recovery is high, but only if timely and adequate assistance is provided to the patient.