Apathy

Introduction Based on the clinical manifestations of underlying diseases and respiratory failure, there is apathy, muscle tremor or flapping tremor, intermittent convulsions, lethargy, and even coma. It can also occur that the sputum reflex is weakened or disappeared, and the pyramidal tract sign is positive. Cerebrovascular disease, metabolic alkalosis, and infectious toxic encephalopathy should be identified.

Cause

Brain cell acidosis is clinically common. PaCO2 has reached a fairly high level, and symptoms of pulmonary cerebral encephalopathy still do not occur. However, if the pH of the cerebrospinal fluid decreases, neuropsychiatric symptoms rapidly occur, and hypercapnia in respiratory failure leads to blood. The concentration of hydrogen ions in the medium increases the pH drop in the blood and respiratory acidosis when it exceeds the buffering capacity of the blood and the compensation range of the kidney. Excessive hydrogen ions in the blood slowly enter the cerebrospinal fluid through the blood-brain barrier, causing the pH of the cerebrospinal fluid to decrease, and the concentration of hydrogen ions in the brain cells to increase, leading to acidosis of the brain tissue.

an examination

Related inspection

EEG sharp wave EEG examination

Blood gas analysis: PaO2 <60mmHg, with a partial pressure of carbon dioxide >50mmHg, the pH change is not as obvious as PaCO2. The actual pH depends on the ratio of bicarbonate to PaO2. When PaCO2 is elevated, but the pH is 7.35, it is called compensatory respiratory acidosis. For example, when pH is <7.35, it is called decompensated respiratory acidosis. Another common clinical condition is that the patient underwent arterial blood gas analysis under oxygen inhalation, PaCO2 increased, but PaO2>60mmHg, which is the performance of type II respiratory failure after oxygen absorption.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Unclearness means that the mind is faint, when the time is clear, the call is ok, or there is a slang.

2. The sorrow and sorrow can respond, but the answer is not asked, the memory and calculation power are poor. The spirit is not concentrated or the mind is unclear.

3. Coma and coma are the most serious disturbances of consciousness caused by the high degree of inhibition of the cerebral cortex and subcortical network, that is, the continuous interruption or complete loss of consciousness, and the high inhibition of the highest level of neurological activity. Clinically, coma is divided into two types: shallow coma and deep coma.

(1) Light coma free movement loss, only less unconscious spontaneous movement, painful stimulation (such as pressure on the upper edge), there are evasive reactions and painful expressions, but can not answer questions or perform simple orders. Swallowing reflexes, cough reflexes, corneal reflexes, and pupils are still present for light reflections, sputum reflexes, and no significant changes in vital signs. It can be accompanied by sputum and swaying.

(2) Deep coma spontaneous movement completely disappeared, muscle relaxation, no response to external stimuli, corneal reflex, pupillary reflex, cough reflex, swallowing reflex and sputum reflex disappeared, irregular breathing, blood pressure decreased. That is, various reactions and reflections disappear. Pathological signs continue to exist or disappear, and there may be changes in vital signs. Coma is a sign of critical illness and should be actively searched for causes and should be actively addressed.

Have a basic disease, and are unresponsive to the outside world, calling no response, but not coma.

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