1/8. Reversible tetraplegia due to polyneuropathy in a diabetic patient with hyperosmolar non-ketotic coma.critical illness polyneuromypathy has not previously been reported as a complication of diabetic coma. We describe a patient with hyperosmolar non-ketotic coma (HONK) complicating gram-negative sepsis in whom persistent coma and profound tetraplegia caused considerable concern. Although, initially, it was feared that the patient had suffered a central neurological complication such as stroke or cerebral oedema, a diagnosis of critical illness motor syndrome (CIMS) was subsequently confirmed neurophysiologically. Profound limb weakness associated with HONK is not necessarily due to a catastrophic cerebral event, rather it may be a result of CIMS, which has an excellent prognosis for full neurological recovery.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/8. acyclovir induced coma in the intensive care unit.A 73-year-old man with multiorgan failure requiring mechanical ventilation and haemodialysis developed herpes labialis infection during his stay in the ICU. This was treated with enteral acyclovir. He developed persistent neurologic impairment soon after acyclovir administration, which, over the course of seven days, progressed to coma, the aetiology of which was unclear. The computed tomograph (CT) of the brain and the cerebrospinal fluid (CSF) examination was normal. The electroencephalogram (EEG) showed generalized slowing. The possibility of acyclovir neurotoxicity was considered and the drug was discontinued. Haemodialysis was instituted and the patient made a complete neurological recovery. We believe that this is the first reported case of coma due to enteral acyclovir.- - - - - - - - - - ranking = 0.85714285714286keywords = coma (Clic here for more details about this article) |
3/8. life-threatening hyperkalaemia following therapeutic barbiturate coma.OBJECTIVE: To report the occurrence of life-threatening hyperkalaemia following treatment with therapeutic thiopentone coma. SETTING: The neurosurgical intensive care units of Royal North Shore Hospital and Liverpool Hospital, Sydney, australia. patients: Three patients treated with theraputic thiopentone coma. One patient with raised intracranial pressure secondary to a severe traumatic brain injury and two patients with refractory vasospasm secondary to subarachnoid haemorrhage. Two of the three patients developed hypokalaemia on starting thiopentone, which was resistant to potassium supplementation. All three patients developed severe hyperkalaemia during the recovery phase of coma. This was life-threatening in all three patients and fatal in one. CONCLUSIONS: Severe hypokalaemia refractory to potassium therapy may occur during therapeutic thiopentone coma. Severe rebound hyperkalaemia may occur after cessation of thiopentone infusion. Protocols for the management of patients with therapeutic barbiturate coma should recognise this potentially serious complication.- - - - - - - - - - ranking = 1.2857142857143keywords = coma (Clic here for more details about this article) |
4/8. rehabilitation of a patient with critical illness polyneuropathy (CIP) following acute respiratory failure: a case report and review of literature.critical illness polyneuropathy (CIP), a neurologic complication that may occur secondary to cardio-respiratory distress, surgery, trauma and coma, is associated with sepsis or multiple organ failure. CIP is characterized by an axonal distal degeneration of sensory and motor fibres. The patients will often become neurologically conspicuous when weaning from mechanical ventilation is unexpectedly difficult. There are just a few cases reported with description of the functional outcome and rehabilitation issues of this condition. An additional CIP case of a 62-year old man complicated with anoxic brain damage during the respiratory distress is reported here. He was referred for rehabilitation, made a remarkable recovery (FIM gain 45!) and returned home after 79 days of treatment in the ward. A review of the pertinent literature is provided. rehabilitation specialists and other professionals working within ICU's should be aware of this condition and be able to recognize and treat CIP at early possible stage.- - - - - - - - - - ranking = 0.14285714285714keywords = coma (Clic here for more details about this article) |
5/8. Hyperosmolar hyperglycemic crisis: an acute life-threatening event in children and adolescents with type 2 diabetes mellitus.OBJECTIVE: To discuss the initial clinical manifestations and management of 8 obese African American children and adolescents who presented with a severe hyper-osmolar hyperglycemic state (HHS) and were newly diagnosed with type 2 diabetes mellitus (DM), except for one who most likely had type 1 DM. methods: We summarize the clinical presentation, pertinent laboratory values, management, complications, outcome, and follow-up of 8 obese pediatric patients who had HHS and alteration of mental function. RESULTS: Seven male and one female African American patients from 11 to 17 years of age with a body mass index that exceeded the 97th percentile were treated for HHS. All patients had alteration of mental status, ranging from confusion to coma. Five patients had venous CO(2) levels <14 mEq/L. Corrected sodium in all patients was in the hypernatremic range in conjunction with high effective serum osmolality. After fluid replacement (the most important aspect of treatment), intravenous insulin therapy was initiated. Metabolic control was achieved in all patients within 36 hours after admission. Complete recovery ensued in all patients except one, who died on the sixth day of hospitalization, possibly attributable to massive pulmonary embolism. CONCLUSION: The incidence of obesity and type 2 DM in children and adolescents is increasing at an alarming rate. Many patients previously undiagnosed with type 2 DM may indeed present with HHS. Because experience and published literature regarding HHS in pediatric patients are meager, this is a new challenge for physicians. mortality and morbidity are high in this group of patients, and a high index of suspicion and awareness of this condition by physicians are warranted.- - - - - - - - - - ranking = 0.14285714285714keywords = coma (Clic here for more details about this article) |
6/8. flumazenil as a diagnostic tool in the differential diagnosis of coma in a critically ill patient.The purpose of this report is to describe the use of flumazenil as a diagnostic aid in the differential diagnosis of coma in a patient with an inadvertent overdose of benzodiazepines. We report a patient with suspected septic encephalopathy whose level of consciousness markedly improved following flumazenil administration. Subsequent analysis revealed the presence of benzodiazepines and their metabolites in the blood and urine although the patient had not received benzodiazepines for over two weeks. The critically ill patient with multiorgan failure may have considerable derangement of benzodiazepine metabolism; therefore, if an obtunded patient's level of consciousness improves following flumazenil administration, benzodiazepine intoxication must be considered.- - - - - - - - - - ranking = 0.71428571428571keywords = coma (Clic here for more details about this article) |
7/8. critical illness myopathy unrelated to corticosteroids or neuromuscular blocking agents.Acute myopathy occurs in critically ill patients, receiving neuromuscular blocking agents or corticosteroids during intensive care hospitalisation. We report three patients with acute quadriplegic myopathy, two of whom were not exposed to corticosteroids or neuromuscular blocking agents. The first of these latter two patients had a history of generalised anoxia with coma related to surgery, complicated by multiple organ failure and sepsis. The second patient, suffering from acute leukaemia, developed sepsis and acute respiratory distress syndrome with the need for mechanical ventilation in the intensive care unit. Electrophysiological studies and muscle biopsy findings were consistent with the diagnosis of critical illness myopathy with loss of myosin filaments. Selective loss of myosin was confirmed by biochemical analysis of muscle. These findings demonstrate that acute myopathy with loss of myosin filaments may occur in patients with severe systemic illness without exposure to corticosteroids or neuromuscular blocking agents.- - - - - - - - - - ranking = 0.14285714285714keywords = coma (Clic here for more details about this article) |
8/8. critical illness polyneuropathy following cardiac surgery.critical illness polyneuropathy (CIP), a neurologic complication which may occur secondary to surgery, trauma and coma, is associated with sepsis or multiple organ failure (MOF). CIP is characterized by an axonal distal degeneration of sensory and motor fibres. The patients will often become neurologically conspicuous when weaning from mechanical ventilation is unexpectedly difficult. In such cases electrophysiologic examinations must be performed. CIP following cardiac surgery is widely unrecognized. The most important aspect of CIP therapy is treatment of the underlying disease, because no specific treatment for CIP exists. We report on a 64-year old patient who developed sepsis and CIP following cardiovascular surgery. The neurological complication was initially misinterpreted as hypoxic brain damage.- - - - - - - - - - ranking = 0.14285714285714keywords = coma (Clic here for more details about this article) |