For example, benzodiazepines and opiates commonly cause respiratory suppression; amphetamines and cocaine cause hypertension, tachydysrhythmias, and myocardial infarction; and tricyclic antidepressants (TCA) may cause conduction block. The impact of drug and alcohol intoxication on Glasgow Coma Scale assessment in patients with traumatic brain injury. Hypotension and prolonged Q-T syndrome are the most common cardiovascular side effects, and these can be life threatening. Cephalosporins are an important cause of drug-induced adverse effects on the central nervous system. They are also referred to as synthetic pot or spice, but are not approved for human use. Valproic acid overdose can be treated with L-carnitine therapy, which can enhance the excretion and help to prevent fatal liver failure. "It . Drug overdoses can be accidental or intentional. Doctors in Catholic hospitals practice palliative sedation even though the Catholic Church opposes aid-in-dying. According to TMZ, the 54-year-old is in an induced coma in the Intensive Care Unit and was given a temporary . Signs and symptoms can include: Comas can have multiple causes. After an initial brief examination, stabilization of the patient, blood and urine sampling, administration of glucose, thiamine, and potentially naloxone, then rapid consideration should be given to neuroimaging to rule out a primary CNS event. "Priscilla Presley and the Presley family are shocked and devastated by. Most other drugs do not have specific antagonists, but deactivation and catharsis of the agent may be effective in decreasing the overall absorption of the medication if still present in the digestive tract. Rare instances of coma have been reported with selected drugs: cefepime, colloidal silver, lamotrigine, intranasal desmopressin with severe hyponatremia, chloroquine, baclofen, tramadol, acyclovir, primidone, bromide, and over-the-counter hypnotics. Dr. JAMES BERNAT (Dartmouth Medical School): The medically induced coma is intended to reduce the metabolic demand of the brain cells. The pupils are typically small but reactive and dilate widely in response to a narcotic antagonist (eg, naloxone). Toxicodynetics in nordiazepam and oxazepam overdoses. Intravenous contrast is most often not required in the acute setting, as a CNS event severe enough to cause coma is most likely to be seen on a noncontrast imaging study. The authors recommended that intoxicating substances should be reversed or allowed to wear off before GCS score is reliably recorded as this can have effects on guiding patient care as well as prognosis. A study on patients presenting with drug-induced coma showed that emergency department physicians underestimate diagnoses of GHB intoxication based on clinical observations alone (17). Extracorporeal sorbent detoxification has been proposed as a means of treating severe tricyclic antidepressant overdose. CT and MR imaging findings in methanol intoxication manifesting with BI lateral severe basal ganglia and cerebral involvement. Loss of consciousness is marked simultaneously by an increase in low-frequency EEG power (< 1 Hz), the loss of spatially coherent occipital alpha oscillations (8-12 Hz), and the appearance of spatially coherent frontal alpha oscillations, which reverse with recovery of consciousness (10). Use of drug antagonists. Most often, the effect of the offending medication is relatively short-lived, and a full recovery may be expected within several days. Coma with drug intoxication can affect any age group, and there is no gender predilection. Lisa Marie Presley, 54, died Thursday while hospitalized in critical condition after reportedly going into cardiac arrest. Pop singer Michael Jackson died from a combination of propofol and lorazepam administered at home. Ann Pharm Fr 2017;75(3):163-71. Childhood Degenerative & Metabolic Disorders, News releases, announcements, interviews and other supplemental content of neurologic interest, Discover upcoming events in neurology and neuroscience, Meet some of the expert physicians who serve as, Stay informed with the latest news in neurology and neuroscience, Listen to clinical cases and topical reviews in neurology, View lists of new and recently updated articles. Hyperbaric oxygen. So basically what happens with a medically induced coma is that you take a drug and administer it until you see a certain pattern in the monitor that follows the patient's brain waves, the EEG. Multiple stages of impairment of consciousness prior to reaching a comatose state include the following (in order of increasing severity): (1) delirium, a state of waxing and waning consciousness with prominent disorientation, fear, and hallucinations, as well as an altered sleep/wake cycle; (2) obtundation, which implies a mild-to-moderate reduction in alertness, with increasing time spent in the sleep state; (3) stupor, a state of deep sleep, from which the patient can be aroused only with repeated and vigorous stimulation; and (4) coma. There are no overall figures for incidence and prevalence of coma due to drug toxicity. He also has kidney problems ( dialysis daily ) which we were told may be due to induced coma? Erdmann A, Werner D, Hugli O, Yersin B. Emergency medical services responders, trained laypeople and the general public (with the support of 911 emergency dispatcher instructions) can administer naloxone to prevent cardiac arrest. Pediatrics 2019;144(2):e02182690.**. In the absence of ancillary history, a toxicology screen should be performed, including serum and urine. Probably a locked-in care setting, because of his tendency to wander. This causes drowsiness and sometimes leads to coma, often with seizures. Young males appear to be particularly susceptible to developing neuroleptic malignant syndrome, and other predisposing factors include dehydration, preexisting cognitive dysfunction, and high doses of higher potency neuroleptics (eg, haloperidol), especially when given as an intramuscular injection. Initial laboratory evaluation revealed normal complete blood count, serum electrolytes, urinalysis, blood urea nitrogen, creatinine, and glucose. Lumbar puncture if there is suspicion of meningoencephalitis. Synthetic cannabinoids are designer drugs that bind to the same receptors to which cannabis plant extracts tetrahydrocannabinol (THC) and cannabidiol (CBD) attach. Cholinergic syndrome. Methamphetamine overdose. Significant hypotension or hypertension should be recognized early, and adequately treated with vasopressor or antihypertensive medications, respectively, to prevent secondary end-organ injury, including injury to the brain. With prolonged unconsciousness after a stroke, infection, or lack of oxygen, the brain is shutting down and will experience a . Intubation and hyperventilation may aid in this process. Drugs producing hyponatremia. Drug-induced respiratory or circulatory failure can also depress the reticular activating system, leading to coma. Direct effect of drugs on the brain. J Neurol Sci 2018;392:137-8. Just ask Dr. Albert Castellon, MD. A coma can result from the direct toxic effect of drugs on the brain or indirect effect due to disturbances of other systems, an article in the journal Neurology MedLink explained. Refractory status epilepticus is a life threatening condition with a mortality rate of up to 40% 8. These compounds can have muscarinic and nicotinic effects. External signs of trauma, particularly to the head (battle sign, raccoon eyes), should alert the physician to the possibility of concomitant head injury. Various methods for clearing the responsible drug in cases of poisoning include plasmapheresis and hemodialysis, but elimination of the drug is dependent on the volume of distribution and the degree of protein binding, both of which can hinder the effectiveness of elimination.
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