The different types of comas

Coma, as a state of the most severe disturbance of consciousness (complete unconsciousness), from which the affected persons cannot be awakened even by strong pain stimuli, can be of different nature, so that – according to the cause – different types of coma can be distinguished:

On the one hand, a coma can result from brain stem damage, especially during/after strokes (cell death), cerebral hemorrhages (bleeding into the brain stem/increase in brain pressure), craniocerebral trauma (direct brain stem damage) or in the context of brain tumors (increase in brain pressure).

Coma diabeticum

Coma diabeticum – also known as diabetic coma – is a type of metabolic coma that can be triggered by a derailment of blood sugar in diabetics. The cause of unconsciousness is always a lack of insulin (due to a lack of or insufficient insulin supply as well as an increased insulin requirement), which means that no more sugar can be absorbed from the blood into the body cells. A distinction is made here between two forms:

The ketoacidotic coma, which is caused by an absolute lack of insulin (typical for type 1 diabetics) and
Hyperosmolar coma caused by relative insulin deficiency (typical for type 2 diabetics).

The absolute lack of insulin, caused by a lack of production in the autoimmune pancreas, means that no more sugar can be absorbed from the blood into the cells, which therefore try to obtain energy in other ways: energy is released by burning proteins and fats, but acidic metabolic products (ketones) are also produced, which gradually acidify the body.

The acidification can then lead to a comatose state. If the insulin deficiency is only relative, there is still enough insulin available to bypass the breakdown of fats and proteins, but the existing insulin is still not sufficient to keep the blood sugar level within the norm. The high blood sugar levels lead to increased urination and thirst, which can lead to a water shortage with transition to a coma.

Both forms are life-threatening conditions and require immediate inpatient treatment. In 25% of the cases of a diabetic coma, which occurs for the first time, it is the first manifestation of diabetes mellitus. There is an almost infinite number of different causes for a coma, which can be divided into 3 large groups: 1. diseases that primarily affect the brain, 2. metabolic disorders that lead to the so-called metabolic coma and 3. toxins or drugs.

Since there can be so many reasons for unconsciousness, only the most important ones can be mentioned here.

1. probably the most common cause is stroke (apoplexy), which can be caused by both vascular occlusion and bleeding Coma occurs mainly when the brain stem is damaged, and the condition then develops very suddenly.
2. craniocerebral trauma and other cranial injuries (here too, brain stem damage is a particular risk) 3. meningitis or other inflammatory diseases of the cerebrum, often accompanied by fever. The coma develops gradually. 4. brain tumors, whereby the coma here is usually not caused directly by the tumor, but by the increase in pressure in the brain caused by it 5. epileptic seizures 6. when the oxygen supply to the brain is cut off, for example when someone is choked
1.
disturbances in sugar metabolism, i.e. both hypoglycaemia and hyperglycaemia, usually in the context of diabetes mellitus, can trigger a coma 2) Insufficient liver function (liver insufficiency) leads to a so-called hepatic coma. 3. insufficient kidney function (renal insufficiency) leads to a so-called uremic coma. 4. if there is a lack of oxygen in the blood (e.g. due to a disturbance of the oxygen uptake by a pulmonary embolism or a circulatory failure due to heart attack/ arrest or lack of fluid) the coma develops within a few seconds
1. alcohol 2. intoxicant 3. medically induced coma under sedation or anaesthesia