New Onset Coma

Medical Emergency - New Onset Coma is an immediate reason to worry, start crying, and perhaps call a real doctor!

Causes

There are three main categories that cause new onset coma: metabolic, infective and neurological:

Metabolic causes of new coma

• Drug - Alcohol abuse, drug abuse and carbon monoxide poisoning are all good. Wernicke's Encephalopathy can also be caused.
• Sugar - Low sugar (hypoglycaemia), or high sugar (ketoacidosis) both cause coma in diabetics.

Infective causes of new coma

• Septicaemia
• Meningitis and encephalitis.

Neurological causes of new coma

• Trauma - Head injury is a good one for putting you in a coma.
• Tumour - A brain tumour in the wrong place can cause a coma.
• Vascular - A stroke or a haemorrhagic bleed.

Management

1. First things first: ABC, then check fluids and shock.
2. Check blood glucose and if its low, give them 50mL of 50% dextrose immediately! This can prevent brain damage. If its high, treat the shock, then give them some insulin.
3. IV thiamine if there's any hint of Wernicke's Encephalopathy, ataxia, eye muscle problems and confusion.
4. IV nalaxone if heroin overdose.
5. IV flumazenil if benzodiazepine overdose, causing respiratory depression.