1/4. Hypercapnic coma due to diaphragmatic involvement in a patient with dermatomyositis.We report an acute respiratory distress by diaphragmatic involvement due to dermatomyositis. A fifty year-old patient with typical dermatomyositis presented an acute respiratory insufficiency with hypercapnic coma due to diaphragmatic muscle involvement. Respiratory state required mechanical ventilation initially and improved secondarily gradually upon corticosteroids and intravenous immunoglobulins. Only few cases of acute respiratory distress in dermatomyositis due to respiratory muscle involvement are reported in literature.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/4. resuscitation from severe acute hypercapnia. Determinants of tolerance and survival.A 46-year-old man underwent cosmetic facial surgery under general anesthesia. He was ventilated by mask with an oxygen-enriched gas mixture for 4 to 6 h and monitored by pulse oximetry. Despite adequate arterial saturation (SaO2 > 90 percent) throughout the procedure, he remained in a deep coma after termination of anesthesia. Initial arterial blood gas analysis revealed a pH of 6.60 and a PaCO2 of 375 mm Hg. The patient was intubated and placed on mechanical ventilation. As his respiratory acidosis resolved, he regained consciousness quickly and recovered without any neurologic deficits. This case of record extreme hypercapnia and review of the literature demonstrates that survival is possible in acute severe respiratory acidosis as long as tissue anoxia and ischemia are prevented. We discuss the tissue effects of acute hypercapnia and newer aspects of the nature of intracellular pH regulation in critical tissues that afford considerable tolerance to acidosis. The dependence of these mechanisms upon active ion transport underscores the importance of adequate tissue oxygenation and perfusion.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
3/4. Profound hypercapnia due to disconnection within an anaesthetic machine.A 25-year-old patient received general anaesthesia for an emergency Caesarean section. Arterial blood gases obtained because of prolonged postoperative coma demonstrated profound hypercapnia (PaCO2 246 mmHg). Examination of the anaesthetic machine revealed a complete disconnection of the metal components of the main gas line downstream from the vaporizer, in a location that was obscured from the anaesthetist's view. Causes of profound hypercapnia are reviewed and preventive measures are discussed.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
4/4. Marked hypochloremic metabolic alkalosis with severe compensatory hypoventilation.In metabolic alkalosis, a compensatory decrease in alveolar ventilation with hypercapnia has been noted only rarely. We recently managed a patient with gastric outlet obstruction from a duodenal ulcer who survived after arriving in the emergency room comatose with severe hypochloremic metabolic alkalosis, compensatory hypoventilation, and hypercapnia. We know of no report in the English literature of a patient with gastric outlet obstruction having a respiratory acidosis or hypochloremia as severe as that in our patient. Proper understanding of the pathophysiology of primary metabolic alkalosis due to gastric losses is necessary to correct the acid-base abnormalities quickly and to restore normal alveolar ventilation.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |