1/7. Hyperosmolar diabetic non-ketotic coma, hyperkalaemia and an unusual near death experience.Generally, cardiac arrest due to pulseless electrical activity has a poor outcome, except when reversible factors such as acute hyperkalaemia are identified and managed early. Hyperosmolar diabetic non-ketotic coma may lead to acute hyperkalaemia. Hyperosmolar diabetic non-ketotic coma is a metabolic emergency usually seen in elderly non-insulin dependent diabetics, characterized by severe hyperglycaemia, volume depletion, altered consciousness, confusion and less frequently neurological deficit. Cerebrovascular accident or transient ischaemic attack may be mistakenly diagnosed, particularly if the patient has no history of diabetes mellitus. Delays in diagnosis and management of glycaemic emergencies presenting as a constellation of neurological abnormalities can be avoided by routine early measurement of blood glucose. Hyperosmolar diabetic non-ketotic coma should be considered in any patient with altered consciousness or neurologic deficit in conjunction with hyperglycaemia. As hyperosmolar diabetic non-ketotic coma results in severe fluid depletion, electrolyte disturbance, profound hyperglycaemia and an altered mental state, the guiding principles of therapy include aggressive rehydration, insulin therapy, correction of electrolyte abnormalities and treatment of any underlying illnesses. Treatment of acute hyperkalaemia includes calcium ions, insulin with dextrose, salbutamol and haemodialysis.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/7. Cardiac failure and multiple organ dysfunction syndrome in a patient with endocrine adenomatosis.In this case report, we present the successful therapy of severe cardiac failure in pituitary adrenal insufficiency. A previously healthy 56-year-old-man in pituitary coma due to an atypical variant of multiple endocrine adenomatosis (pituitary adenoma and pheochromocytoma) suffered from cardiac failure resistant to catecholamine and standard hydrocortisone therapy. After two bolus injections of dexamethasone (2 x 24 mg) mean arterial pressure and cardiac function dramatically improved, probably due to restoration of permissive effects on catecholamine action and reversal of pathophysiological mechanisms of cardiac failure. We conclude that in patients with severe cardiovascular failure in pituitary coma the administration of potent glucocorticoids may be more effective in reversing cardiovascular failure than standard dosages of hydrocortisone.- - - - - - - - - - ranking = 0.25keywords = coma (Clic here for more details about this article) |
3/7. Adriamycin-induced cardiomyopathy aggravated by cis-platinum nephrotoxicity requiring dialysis.Complications of chemotherapy for a synovial sarcoma in an eight-year old boy included cisplatinum nephrotoxicity and adriamycin cardiotoxicity. The resultant renal failure and fluid overload necessitated peritoneal dialysis. Intractable hypomagnesemia was also a prominent feature.- - - - - - - - - - ranking = 0.125keywords = coma (Clic here for more details about this article) |
4/7. Refractory right ventricular failure due to granulocytic sarcoma.A 72-year-old white man had granulocytic sarcoma (chloroma) characterized by right ventricular failure. Seven years before his final hospitalization, a diagnosis of agnogenic myeloid metaplasia was made on bone marrow biopsy, and the patient was treated with phosphorus 32. Three months before his death, the patient developed refractory right ventricular failure. biopsy of a mass in the anterior abdominal wall demonstrated granulocytic sarcoma. The patient died 10 days after the biopsy was performed. autopsy showed disseminated granulocytic sarcoma with massive encasement of the heart and the great vessels. This finding can, in retrospect, explain the hemodynamic abnormalities that led to the patient's death. This is, to our knowledge, the first case report of granulocytic sarcoma diffusely involving the heart and causing refractory right ventricular failure in a patient with a long-standing history of agnogenic myeloid metaplasia.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/7. Hypoglycemic coma after cardiac surgery.Hypoglycemic coma occurring 5 h after cardiac surgery in a nondiabetic adult patient was primarily triggered by: low cardiac output leading to severe hepatic functional derangement; metabolic acidosis, probably secondary to peripheral hypoperfusion; and possible inhibition of the adrenergic response due to anesthesia with fentanyl. Glucose infused at 8 g/h progressively increased the blood glucose level and paralleled hemodynamic improvement.- - - - - - - - - - ranking = 0.625keywords = coma (Clic here for more details about this article) |
6/7. Cardiac failure aggravated by timolol eye drops: preoperative improvement by changing to pilocarpine.A 73-year-old woman with cardiac dysfunction had several episodes of severe bradycardia and pulmonary oedema when waiting for peripheral vascular surgery. She used timolol eye drops for primary open-angle glaucoma. The first episode of pulmonary oedema occurred two weeks prior to and the second on the day before the planned surgery. There were another two episodes of pulmonary oedema before she was transferred to the Department of internal medicine where she had a further two episodes of cardiac failure. After changing timolol to pilocarpine eye drops, the patient's condition was stabilized, and two weeks later surgery and postoperative recovery were uneventful.- - - - - - - - - - ranking = 0.125keywords = coma (Clic here for more details about this article) |
7/7. Reversible cardiac failure in an adolescent after prolonged exposure to carbon monoxide.We describe the case of an adolescent who developed a severe but fully reversible cardiac dysfunction with low blood levels of carboxy haemoglobin (COHb = 10%) after a prolonged exposure to carbon monoxide. A 15-year-old male was admitted with a glasgow coma scale of 8/15 with suspected postictal state and postanoxic encephalopathy. The cardiorespiratory failure which he developed soon after admission mandated mechanical ventilation, inotropic support and ultimately left ventricular support by intra-aortic balloon counterpulsation. The cardiac dysfunction was documented by radionuclide imaging and echocardiography. The patient fully recovered without neurological deficit. A low blood COHb concentration is a poor safety indicator since high tissue levels of accumulated carbon monoxide can be associated with coma and fulminant cardiorespiratory failure requiring advanced life support facilities.- - - - - - - - - - ranking = 0.125keywords = coma (Clic here for more details about this article) |