Coma due to alcohol

Depending on the concentration of alcohol in the blood, a distinction is made between different stages of alcohol poisoning. From an alcohol concentration of 4.0 per mille, a life-threatening alcoholic coma can occur, a failure of the function of all vital organs (multiorgan failure) can follow, and the body’s reflexes and breathing are significantly reduced or even fail completely. Due to the existing acute danger to life, this condition must be treated as soon as possible as an in-patient, intensive care in a hospital.

The reason for the alcoholic coma is the toxicity of alcohol: the liver, as an alcohol-degrading or alcohol-eliminating organ, is fully utilized when a certain amount of alcohol is consumed. In addition, the breakdown of alcohol always produces toxic by-products (acetaldehyde), which accumulate in the blood together with the ethanol. These two cytotoxins primarily damage liver and nerve cells, but they also have a highly damaging effect on all other organ systems.

Nerve cell damage or paralysis and nerve cell death in the area of the brain stem is the cause of loss of consciousness up to coma, of reflexes and respiratory depression. The correct and above all rapid diagnosis of coma is of crucial importance. First of all, the unconscious person is addressed and an attempt is made to wake him or her up and their reflexes are tested.

For example using the Glasgow Coma Scale (see above)then a first more exact estimate of its condition can be given. It is also important to interview people present who may have seen a possible cause of the coma (for example, in poisoning or accidents) or because they know the patient’s medical history, for example, they can tell the doctor whether the person concerned suffers from previous illnesses such as diabetes mellitus. Then the doctor checks the vital signs (pulse, blood pressure and respiration).

If an ECG device is available, it should be connected in order to provide more precise information about heart function. Of course, first aid must be provided during this time. After the first aid measures on site, depending on the cause of the coma, further examinations can be carried out, for example, examination of blood or brain fluid (liquor diagnostics), an X-ray, an ultrasound, a computer tomography (CT), a magnetic resonance tomography (MRT), an electroencephalogram (EEG) and many others.

The prognosis of a coma patient depends mainly on the underlying disease and medical care and therefore cannot be generalized. A coma can only be of very short duration. If the brain is not supplied with sufficient oxygen for a short period of time, a person affected usually becomes unconscious and falls over.

This often improves the blood flow to the brain to such an extent that the patient spontaneously recovers after a few seconds and regains full consciousness. This is called “syncope”. The same applies to epileptic seizures.

However, the comatose state can last for several days or even weeks. Then, however, the condition of the affected person must improve or brain death will occur. Some of the patients slip into a waking coma (apallic syndrome) or regain a minimal state of consciousness, some also regain full consciousness but remain (almost) completely paralyzed (locked-in syndrome).