1/17. Marked hyperthermia as a manifestation of hypoglycemia in long-standing diabetes mellitus.Hyperthermia has recently been recognized as a manifestation of hypoglycemia. We describe two episodes of hypoglycemia associated with nausea, vomiting, chills, and impaired consciousness which were followed by marked hyperthermia. We suggest that the hyperthermia may result from excessive reaction to preceding hypothermia caused by the hypoglycemia. We would like to alert the clinician to the possibility of a previous, severe hypoglycemic episode in any diabetic patient with hyperthermia and coma.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/17. Confounding factors in diagnosing brain death: a case report.BACKGROUND: brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. CASE PRESENTATION: A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological features of brain death but concurrent profound hypothyroidism precluded the diagnosis. Our clinical and ethical decisions were further challenged by another facet of this complex case. Although her brain damage indicated a hopeless prognosis, we could not discontinue care based on futility because the only known surrogate was mentally retarded and unable to participate in medical planning. CONCLUSION: The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. While prognostication is important in deciding to withdraw care, it is not a component in diagnosing brain death.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/17. Accidental hypothermia with cardiac arrest: recovery following rewarming by cardiopulmonary bypass.A 22-year-old man eventually had a good neurologic recovery following prolonged coma after extracorporeal rewarming from profound hypothermia (24 degrees C) due to exposure. The patient was in full arrest for 60 minutes prior to institution of cardiopulmonary bypass (CPB). Total bypass time was 50 minutes. cardiopulmonary bypass is the current rewarming method of choice for severe hypothermia associated with a persistent nonperfusing cardiac rhythm. CPB provides the most rapid core rewarming with the additional benefit of circulatory support during the period of cardiac instability.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/17. survival after prolonged submersion in freshwater in florida.A 2-year-old boy was submerged for at least 20 min in a freshwater creek in Union County, FL. cardiopulmonary resuscitation (CPR) was administered for approximately 1 h at the scene and during transport to the hospital. On arrival, his glasgow coma scale score was 3 and rectal temperature was < or = 26.7 degrees C. He demonstrated respiratory failure, intense vasoconstriction, hemoglobinuria, anemia, hypercoagulability, thrombocytosis, leukopenia, and persistent coma. With intensive care, he began emerging from the coma after 72 h and progressively improved. Testing at the Developmental Evaluation Center and clinical observations showed him to be completely normal by 6 months after drowning. Thus, severe, rapid hypothermia can occur during drowning in cold water in any geographic location and at temperatures above those necessary for ice formation. hypothermia provides cerebral protection from hypoxia, permitting total recovery with appropriate CPR and intensive care.- - - - - - - - - - ranking = 3keywords = coma (Clic here for more details about this article) |
5/17. hypothermia in three patients with multiple sclerosis.hypothermia, defined as a core temperature less than 35 degrees C has multiple causes and several neurological consequences. The cases of three patients with definite multiple sclerosis since more than a decade are reported, who presented with several episodes of coma and hypothermia. Systematic neuropathologic examination of the hypothalamus in one case did not reveal any abnormality.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/17. A case of myxoedema coma successfully treated by low dose oral triiodothyronine.Myxoedema coma is fortunately rare and is probably rarer in a warm climate such as australia. It carries a high mortality rate. Its correct management is still a controversial issue. A case of severe myxoedema coma who was successfully treated is described. Thyroid hormone was replaced in the form of triiodothyronine given orally in doses of 20-40 microng/day. There was an improvement in body temperature within six hours of the first dose; this was accompanied by a brisk fall in serum CPK and cholesterol with a rapid rise of plasma T3 into the euthyroid range. There was a defect in water excretion which was rapidly reversed as renal function returned to normal. review of the literature suggests that low dose oral therapy with T3 is a satisfactory form of initial management.- - - - - - - - - - ranking = 6keywords = coma (Clic here for more details about this article) |
7/17. Delayed recovery from general anaesthesia.A case of postoperative coma associated with diabetes insipidus and hypothermia is presented. Some recommendations are offered for the future management of similar cases.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/17. Hypothermic myxedema coma erroneously diagnosed as myocardial infarction because of increased creatine kinase MB.As is well recognized, activities of creatine kinase (CK, EC 2.7.3.2) and lactate dehydrogenase (EC 1.1.1.27) in plasma may be substantially increased in hypothyroidism. We emphasize here that an increase and decrease in CK-MB isoenzyme, characteristic of acute myocardial infarction, can occur in hypothermic myxedema coma without myocardial infarction.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
9/17. Cardiac enzyme changes in myxedema coma.A 74-year-old man with myxedema and hypothermia had increased activities in plasma of creatine kinase (CK; EC 2.7.3.2), aspartate aminotransferase (AST; EC 2.6.1.1), and lactate dehydrogenase (LD; EC 1.1.1.27) and increased proportions of CK-MB (up to 20% of total CK) and LD1 isoenzymes, but no clinical or investigational evidence of associated myocardial infarction. This case illustrates that plasma enzyme activity and isoenzyme profiles in such clinical settings should be interpreted with caution, because increases in CK-MB and LD1 may relate to myxedema coma or hypothermia (or both) rather than to myocardial infarction.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
10/17. hypoglycemia: causes, neurological manifestations, and outcome.During a 12-month prospective study there were 125 visits to the Harlem Hospital Emergency Room for symptomatic hypoglycemia. Sixty-five patients had obtundation, stupor, or coma; 38 had confusion or bizarre behavior; 10 were dizzy or tremulous; 9 had had seizures; and 3 had suffered sudden hemiparesis. diabetes mellitus, alcoholism, and sepsis, alone or in combination, accounted for 90% of predisposing conditions; others included fasting, terminal cancer, gastroenteritis, insulin abuse, and myxedema. Average blood glucose levels were lower among comatose than among obtunded patients, but overlap was considerable, and overall there was little correlation among cause, blood glucose levels, and symptoms. Although mortality was 11%, only one death was attributable to hypoglycemia per se, and only four survivors had focal neurological residua.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |
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