CNS depressant induced coma
Introduction
Introduction Central nervous system inhibitor-induced coma is one of the types of pituitary crisis and pituitary stroke crisis, that is, when the anterior pituitary dysfunction, adrenocortical hormone and thyroid hormone deficiency, the body's stress ability declines, in infection, vomiting, diarrhea, In the case of dehydration, cold, hunger, etc., and using hypnotics or anesthetics to induce crisis. Pituitary tumor sudden intratumoral hemorrhage, infarction, necrosis, tumor expansion, causing acute neuroendocrine lesions called pituitary apoplexy.
Cause
Cause
When the function of the anterior pituitary is diminished, the adrenal cortex hormone and thyroid hormone are deficient, and the body's stress ability is reduced, which is caused by infection, vomiting, diarrhea, dehydration, cold, hunger, and the application of sleeping pills or anesthetics.
Examine
an examination
Related inspection
Dynamic electrocardiogram (Holter monitoring) pulse blood pressure
1. History, symptoms and signs:
(1) Type of crisis:
1. Hypoglycemia coma: The most common, more than eating too little, starving or fasting or after the injection of insulin. It is characterized by hypoglycemia; fainting (may have epileptic seizures, even coma) and hypotension. A history of hypopituitarism can be diagnosed by detecting hypoglycemia.
2. Infection-induced coma: manifested as high fever, coma after infection, and hypotension.
3. Central nervous system inhibitors induce coma: the general dose of sedatives and anesthetics can cause patients to fall into a long period of slumber and even coma. According to the medical history is not difficult to diagnose.
4. Low temperature coma: more induced by cold in winter, characterized by hypothermia and coma.
5. Loss of sodium coma: mostly due to surgery or gastrointestinal dysfunction caused by sodium dehydration, leading to peripheral circulatory failure.
6. Intoxication in water: Due to the original drainage disorder of the disease, excessive water intake can cause water poisoning. Mainly manifested as water retention syndrome, hyponatremia and decreased hematocrit.
(2) Pituitary stroke:
The main performance is:
1 sudden onset of symptoms of increased intracranial pressure;
2 often have symptoms of adjacent tissue compression in the sella, such as upward oppression of visual pathways, diencephalon and midbrain, causing vision loss, visual field defects and changes in vital signs; downward pressure on the thalamus causes blood pressure, body temperature, respiration and heart rhythm disorders; Entry into the cavernous sinus causes extraocular muscle paralysis, trigeminal symptoms and venous reflux disorders;
3 symptoms of hypothalamic-pituitary dysfunction. There are still many patients with pituitary apoplexy who lack the symptoms of the original pituitary adenoma. Therefore, patients with unexplained sudden increases in intracranial pressure, especially those with visual impairment, eye muscle paralysis and other symptoms, should be alert to pituitary apoplexy.
2. Auxiliary inspection:
1. Determination of endocrine function:
It shows that the pituitary hormone and the corresponding target gland hormone are simultaneously reduced.
(1) Reduction of target gland hormones and their metabolites in the blood (T3, T4, FT3, FT4, TSH, ACTH, P, T, E2, FSH, LH);
(2) After several days of continuous excitatory stimulation of pituitary hormones (TSH, CTH, LH), the target gland hormones gradually increased, showing a delayed response, which can be differentiated from primary target gland hypofunction.
(3) There was no response in the TRH, CRH, and LHRH stimulation tests.
2. Sella X-ray:
Sella enlargement can be seen in hypothalamic or pituitary tumors. The microadenomas have no enlargement but can have localized damage. CT or MRI can help further diagnosis.
Diagnosis
Differential diagnosis
Coma is the most severe disturbance of consciousness due to the high degree of inhibition of the cerebral cortex and subcortical reticular formation, that is, the sustained inhibition of consciousness or the complete loss of the highest inhibition of the highest level of neurological activity. Clinically, coma is divided into two types: shallow coma and deep coma.
Sedation, anaesthetic-induced coma: patients with anterior pituitary hypofunction crisis are very sensitive to sedation and anesthesia. The commonly used amount can cause the patient to fall into a long period of slumber and even coma.
Patients with hypoplasia of the anterior pituitary will develop a toxic coma in the water. Water poisoning is nausea, vomiting, collapse, insanity, convulsions and coma.
