Sedation, narcotic-induced coma

Introduction 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. The patient is 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. After intravenous injection of 0.1 g of sodium pentobarbital or less than 0.1 g of thiopental, the patient enters the third stage of anesthesia and maintains a semi-coma for 2 days. 16 mg of morphine can cause coma for 2 days. 0.1 gram of barbital and 50 mg of meperidine can cause coma. Long-term lethargy can also occur after receiving a general therapeutic dose of chlorpromazine (oral or intramuscular).

Cause

1. Avascular necrosis of the anterior pituitary: the postpartum pituitary necrosis is called Sheehan syndrome. Pituitary ischemic infarction can also occur in diabetic microangiopathy.

2. Pituitary and hypothalamic tumors.

3. Pituitary invasive disease: leukemia, sarcoidosis, etc.

4. Autoimmune pituitary inflammation.

5. Others: radiation therapy and chemotherapy; pituitary resection; pituitary abscess, tuberculosis, encephalitis, skull base meningitis and other infectious diseases; empty sella syndrome (rare).

6. Idiopathic: mostly a single hormone deficiency.

an examination

Sedation, narcotics caused by lethargy, coma patients with sedation, anaesthesia are very sensitive, the usual dose can make patients fall into a long period of slumber and even coma. After intravenous injection of 0.1 g of sodium pentobarbital or less than 0.1 g of thiopental, the patient enters the third stage of anesthesia and maintains a semi-coma for 2 days. 16 mg of morphine can cause coma for 2 days. 0.1 gram of barbital and 50 mg of meperidine can cause coma. Long-term lethargy can also occur after receiving a general therapeutic dose of chlorpromazine (oral or intramuscular).

Differential diagnosis

Infection-induced coma: coma acute onset is common in infections. These infectious diseases include:

1 virus infection: such as epidemic encephalitis, forest encephalitis, meningoencephalitis, enteroviral encephalitis, epidemic hemorrhagic fever, encephalitis-type influenza, etc.; 2 ricketts infection; 3 parasitic infections : such as cerebral malaria, acute cerebral schistosomiasis, diffuse cerebral cysticercosis, etc.; 4 infection of toxic encephalopathy: such as toxic pneumonia, toxic dysentery, sepsis, etc.; 5 spirochete infection. Serious infections: pneumonia, typhoid fever, malaria, Huafu syndrome, etc., cerebrospinal fluid or leukocytosis, often without focal symptoms.

Central nervous system inhibitors induce coma: one of the types of pituitary crisis and pituitary stroke crisis, that is, when the anterior pituitary dysfunction, the adrenal cortex hormone and thyroid hormone deficiency, the body's stress ability decreased, 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.

Near-compulse coma: Hepatoencephalopathy (hepatoencephalopathy) used to be called hepatic coma. It is a comprehensive symptom of central nervous system dysfunction caused by severe liver disease and is one of the manifestations of severe liver cell function failure. The main symptoms are conscious disturbance, behavioral disorder and coma, while occult hepatic encephalopathy has no obvious clinical manifestations and biochemical abnormalities. Only a fine intelligence test and/or electrophysiological test can be used to make a diagnosis. Portal shunt encephalopathy is the most common, the main mechanism of occurrence is portal hypertension, there is a collateral circulation between the portal vein and the vena cava, so that a large number of portal vein blood bypasses the liver and the human body circulates.

Sedation, narcotics caused by lethargy, coma patients with sedation, anaesthesia are very sensitive, the usual dose can make patients fall into a long period of slumber and even coma. After intravenous injection of 0.1 g of sodium pentobarbital or less than 0.1 g of thiopental, the patient enters the third stage of anesthesia and maintains a semi-coma for 2 days. 16 mg of morphine can cause coma for 2 days. 0.1 gram of barbital and 50 mg of meperidine can cause coma. Long-term lethargy can also occur after receiving a general therapeutic dose of chlorpromazine (oral or intramuscular).

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