Conditions that may cause disorders of 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 [glucose > 600 mg/d].
- 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 pyloric 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.
- Hypocalcemic tetany – neuromuscular hyperexcitability due to a deficiency of calcium.
- Hypokalemic tetany – neuromuscular hyperexcitability due to a deficiency of potassium.
- Hyponatremia (sodium deficiency).
- Pituitary insufficiency (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
- Intracranial hemorrhage (coma is associated in 21% of cases).
- Silent myocardial infarction (heart attack).
- Subarachnoid hemorrhage (SAB; hemorrhage between the spinal meninges 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).
In 75-80% of cases, an aneurysm (outpouching of an artery) is the cause.
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 in psychiatric diseases or injuries/tumors of the brain.
- Epilepsy (coma is associated in 23% of cases).
- Increased intracranial pressure
- Brain abscess – encapsulated collection of pus in the brain.
- Meningoencephalitis – combined inflammation of the brain (encephalitis) and meninges (meningitis).
- Psychogenic pseudocoma
Genitourinary system (kidneys, urinary tract – reproductive 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).
- Alpha-sympatholytics (phenoxybenzamine).
- Antiviral therapy (aciclovir, brivudine, cidofovir, efavirenz, famciclovir, fomivirsen, foscarnet, ganciclovir, lopinavir, rilpivirine, ritonavir, tenofovir, valganciclovir, zidovudine).
- Calcium antagonists (amlodipine, diltiazem, felodipine, fendiline, gallopamil, lacidipine, lercanidipine, nitrendipine, nifedipine, nimodipine, nicardipine, isradipine, nisoldipine, nilvadipine, manidipine, verapamil)
- Hormones
- Hypnotics
- Muscle relaxants
- Benzodiazepines (tetrazepam* ) [* prescription ban since August 2013 due to serious skin reactions such as Stevens-Johnson syndrome or erythema multiforme]
- Opiates or opioids (alfentanil, apomorphine, buprenorphine, codeine, dihydrocodeine, fentanyl, hydromorphone, loperamide, morphine, methadone, nalbuphine, naloxone, naltrexone, oxycodone, pentazocine, pethidine, piritramide, remifentanil, sufentanil, tapentadol, tilidine, tramadol).
- Parasympathomimetics
- Indirect parasympathomimetics (cholinesterase inhibitors): alkylphosphates, distigmine, donepezil, galantamine, neostigmine, physostigmine, pyridostigmine, rivastigmine, tacrine
- Sedatives
- Triptans (sumatriptan)
Environmental exposures – intoxications (poisonings) (coma is associated with intoxications/poisonings in 18% of cases).
- Intoxications, e.g.:
- Alkaloids
- Alcohol
- Hypnotics (sleeping pills)
- Carbon monoxide
- Hydrocarbons (aliphatic, aromatic)
- Opiates (painkillers such as morphine)
- Sedatives (tranquilizers)
- Hydrogen cyanide/potassium cyanide