Conditions that can lead to impaired consciousness:
Respiratory system (J00-J99)
Endocrine, nutritional and metabolic diseases (E00-E90).
- Addison’s crisis – decompensated Addison’s disease; this describes primary adrenocortical insufficiency resulting in, among other things, failure of cortisol production.
- Coma basedowicum – coma in metabolic derailment in the context of Graves’ disease (thyroid disease).
- Coma diabeticum (coma in metabolic derailment in the context of diabetes mellitus/sugar disease):
- Diabetic ketoacidosis (DKA; synonym: ketoacidotic coma; severe metabolic derailment (ketoacidosis) in insulin deficiency) – predominantly in type 1 diabetes mellitus.
- Hyperosmolar nonketotic coma or syndrome (HNKS; synonyms: hyperosmolar diabetic coma; hyperglycemic coma) – typical in diabetes mellitus type 2.
- Coma hypochloraemicum – coma in metabolic derailment in the context of a severe salt deficiency syndrome.
- Coma hypoglycaemicum – coma due to severe hypoglycemia (hypoglycemia).
- Coma posthypoglycaemicum – coma after a prolonged hypoglycemia (hypoglycemia).
- Coma pyloricum – coma in metabolic derailment in the context of decompensated pyloric stenosis (gastric orifice stenosis).
- Hypercalcemic crisis – life-threatening form of hyperparathyroidism (parathyroid hyperfunction).
- Hyperproteinemic coma (hyperviscosity syndrome, HVS) – coma due to a change in the viscosity of the blood, resulting in a restriction of flow.
- Hypokalemic tetany – neuromuscular hyperexcitability due to a deficiency of potassium.
- Hypocalcemic tetany – neuromuscular hyperexcitability due to a deficiency of calcium.
- Hypopituitarism (hypopituitarism) – inability of the pituitary gland (pituitary gland) to produce enough hormones.
- Myxedema coma (hypothyroid coma) – life-threatening course of hypothyroidism (hypothyroidism), which is accompanied by a severe disturbance of consciousness.
Cardiovascular system (I00-I99).
- Apoplexy (stroke)
- Basilar artery thrombosis – occlusion of a basilar artery of the brainstem associated with severe neurologic damage.
- Chronic subdural hematoma (cSDH) – hemorrhage between layers of the meninges that can lead to various neurological symptoms.
- Cerebral sinus thrombosis – occlusion of a venous cerebral blood duct.
- Brainstem hemorrhage
- Brainstem infarction
- Subarachnoid hemorrhage (SAB; hemorrhage between the spider tissue membrane and the soft meninges; incidence: 1-3%); symptomatology: proceed according to “Ottawa rule for subarachnoid hemorrhage”:
- Age ≥ 40 years
- Meningismus (symptom of painful neck stiffness in irritation and disease of the meninges).
- Syncope (brief loss of consciousness) or impaired consciousness (somnolence, sopor and coma).
- Onset of cephalgia (headache) during physical activity.
- Thunderclap headache/destructive headache (about 50% of cases).
- Restricted mobility of the cervical spine (Cervical spine).
Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).
- Hepatic failure coma – coma that may develop during the course of liver cirrhosis (irreversible damage to the liver leading to gradual connective tissue remodeling of the liver with impairment of liver function)
- Hepatic decay coma (endogenous hepatic coma) – coma caused by acute demise of liver cells.
Neoplasms – tumor diseases (C00-D48).
- Brain tumors, unspecified
Psyche – nervous system (F00-F99; G00-G99).
- Coma vigile (akinetic mutism) – muteness with general inhibition of motor functions, which is mainly conditioned by psychiatric diseases or injuries/tumors of the brain.
- Epilepsy
- Increased intracranial pressure
- Brain abscess – encapsulated collection of pus in the brain.
- Brain edema (swelling of the brain)
- Meningoencephalitis – combined inflammation of the brain (encephalitis) and meninges (meningitis).
Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).
- Coma uremicum – coma caused by uremia (occurrence of urinary substances in the blood above normal values).
Causes (external) of morbidity and mortality (V01-Y84).
- Coma dyspepticum (infantum) – coma caused by desiccosis (dehydration) in an infant in the context of intoxication (poisoning), usually after an intestinal infection.
Injuries, poisoning, and other sequelae of external causes (S00-T98).
- Brain contusion (brain contusion)
- Brain mass hemorrhage
Medication
- Antiarrhythmics
- Class Ib antiarrhythmics (lidocaine).
- Acetylcholinesterase inhibitors (donezepil, galantamine, rivastigmine).
- Alpha-sympatholytics (phenoxybenzamine).
- Hypnotics
- Muscle relaxants
- Benzodiazepines (tetrazepam)
- Opiates
- Sedatives
- Triptans (sumatriptan)
Environmental pollution – intoxications (poisoning).
- Intoxications as caused by:
- Alkaloids
- Alcohol
- Hypnotics (sleeping pills)
- Carbon monoxide
- Hydrocarbons (aliphatic, aromatic)
- Opiates (painkillers such as morphine)
- Sedatives (tranquilizers)
- Hydrogen cyanide/potassium cyanide
Differential diagnoses of hyperosmolar coma
Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)
- Acute abdomen-acute abdominal pain with guarding that may be due to many different conditions
