Coma: Difference between revisions

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__NOTOC__
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
{{Coma}}
{{CMG}}  '''Associate Editor(s)-in-Chief:''' [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:ravitheja.g@gmail.com] 


{{Infobox_Disease |
==[[Coma overview|Overview]]==
| Name  = Coma
| ICD10 = {{ICD10|R|40|2|r|40}}
| ICD9  = {{ICD9|780.01}}
}}
{{SI}}
{{CMG}}  '''Associate Editor(s)-in-Chief:''' [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:rgudetti@perfuse.org] 


==Overview==
==[[Coma historical perspective|Historical Perspective]]==
In [[medicine]], a '''coma''' (from the [[Greek language|Greek]] {{polytonic|κῶμα}} ''koma'', meaning deep sleep) is a profound state of [[unconsciousness]]. A comatose patient cannot be awakened, fails to respond normally to pain or light, does not have sleep-wake cycles, and does not take voluntary actions. Coma may result from a variety of conditions, including [[intoxication]], [[metabolism|metabolic]] abnormalities, central nervous system diseases, acute neurologic injuries such as [[stroke]], and [[Hypoxia (medical)|hypoxia]]. It may also be deliberately [[induced coma|induced]] by pharmaceutical agents in order to preserve higher brain function following another form of brain trauma, or to save the patient from extreme pain during healing of injuries or diseases. A coma may also result from immense [[head trauma]] caused by something like a car accident or a series of very severe [[concussion]]s. The underlying cause of the coma is bilateral damage to the [[Reticular formation]] of the [[midbrain]], which is important in regulating sleep <ref> The Human Brain: an introduction to its functional anatomy 5th ed by J Nolte chpt 11 pp262-290 </ref>.


== Differential Diagnosis of Causes of Coma==
==[[Coma pathophysiology|Pathophysiology]]==
(Most common causes)
* Cerebral masses
* [[Diabetic coma]]
* [[Encephalitis]]
* [[Encephalomyelitis]]
* [[Endocrine encephalopathies]]
* [[Heart failure]]
* [[Head trauma]]
* [[Heatstroke]]
* [[Hepatic encephalopathy]]
* [[End stage renal disease]]
* [[Intoxication]]
* [[Poisoning]]
* [[Pulmonary embolism]]
* [[Psychoses]]
* [[Ddx:Intracranial Bleeding|Subarachnoid hemorrhage]]
* [[Ddx:Syncope|Syncopes]]


==[[Coma causes|Causes]]==


===By organ system===
==[[Coma differential diagnosis|Differentiating Coma from other Diseases]]==
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Heart attack]], [[Heart failure]], [[Malignant hypertension]], [[Shock]], [[Ventricular fibrillation]], [[Very low blood pressure]], [[Ddx:Cardiac Dysrhythmias|Cardiac dysrhythmias]], [[Endocarditis]], [[Rheumatic Fever]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[1,1-Dimethylhydrazine poisoning]], [[2-Methyl-4-Chlorophenoxyacetic Acid poisoning ]], [[Acetone poisoning]], [[Acetylene poisoning ]], [[Ackee Fruit Food poisoning ]], [[Acrolein poisoning]], [[Acute Chemical poisoning -- Varnish makers' and painters' Naptha]], [[Acute xylene poisoning]], [[Aftershave poisoning]], [[Alcohol intoxication]], [[Aldrin poisoning]], [[Alicyclic hydrocarbons poisoning]], [[Allethrin poisoning]], [[Amanita polypyramis poisoning]], [[Amidithion poisoning]], [[Amiton poisoning]], [[Ammonium Bifluoride]], [[Ammonium Sulfamate  poisoning]], [[Anchovy (clupeotoxin) poisoning ]], [[Aniline poisoning]], [[Antifreeze poisoning]], [[Amyl Alcohol]], [[Aristolochic acid]], [[Arsenic]],  [[Apricot seed poisoning]], [[Azinfos-methyl poisoning]], [[Azinphos-ethyl poisoning]], [[Azinphosmetile poisoning]], [[Azothoate poisoning]], [[Benoxafos  poisoning]], [[Bentazon poisoning]], [[Benzene toxicity]], [[Beta ketothiolase deficiency]], [[Bird cherry seed poisoning]], [[Bitter almond seed poisoning]], [[Black henbane poisoning]], [[Black jetbead poisoning]], [[Blue-ringed octopus poisoning]], [[Boric Acid]], [[Box Jellyfish poisoning]], [[Bromide toxicity]], [[Bromoform poisoning]], [[Butyl Alcohol poisoning]], [[Camphor]], [[Cannabinoids]], [[Carbamate insecticide poisoning]], [[Carbaryl]], [[Carbinoxamine]], [[Carbon monoxide poisoning]], [[Carbon Tetrachloride]], [[Carbophenothion]], [[Celandine poisoning]], [[Cherry laurel seed poisoning]], [[Cherry seed poisoning]], [[Chlophedianol toxicity]], [[Chloral hydrate poisoning]], [[Chlorate salts poisoning]], [[Chlorfenvinphos poisoning]], [[Chloromethane poisoning]], [[Chloropyrifos poisoning]], [[Chlorpyrifos poisoning]], [[Chokecherry seed poisoning]], [[Christmas Cherry poisoning]], [[Chromium poisoning]], [[Clupeotoxism]], [[Cobra poisoning]], [[Cocaine]], [[Common poppy poisoning]], [[Cone shell poisoning]], [[Copper toxicity]], [[Coumaphos poisoning]], [[Cresols poisoning]], [[Cresylic acid poisoning]], [[Cyanide poisoning]], [[Daphne poisoning]], [[Darvocet overdose]], [[Death Angel poisoning]], [[Death Camas poisoning]], [[Demethyldiazepam toxicity]], [[Demeton-O-methyl poisoning]], [[Demeton-S-methyl poisoning]], [[Demeton-S-methylsulphon poisoning]], [[Devil's trumpet poisoning]], [[Dialifos poisoning]], [[Diazinon poisoning]], [[Dichloralphenazone poisoning]], [[Dichloronaphthoquinone poisoning]], [[Dichlorvos poisoning]], [[Dicrotophos poisoning]], [[Dieldrin poisoning]], [[Diethylene Glycol poisoning]], [[Dimethoate poisoning]], [[Dimethyl Phthalate poisoning]], [[Dinitrocresol poisoning]], [[Dinitrophenol poisoning]], [[Di-n-Octyl phathalate poisoning]], [[Dioxathion poisoning]], [[Disulfoton poisoning]], [[Endothion poisoning]], [[English Ivy poisoning]], [[English Laurel poisoning]], [[Ethchlorvynol poisoning]], [[Ethion poisoning]], [[Ethoate-methyl poisoning]], [[Ethoprophos poisoning]], [[Ethylene Glycol poisoning]], [[Ethyl-guthion poisoning]], [[Etrimfos poisoning]], [[Eucalyptus Oil poisoning]], [[Fenchlorphos poisoning]], [[Fenitrothion]], [[Fensulfothion]], [[Fenthion poisoning]], [[Fire cherry poisoning]], [[Fonophos poisoning]], [[Formaldehyde poisoning]], [[Formothion poisoning]], [[Funnel Web spider poisoning]], [[Hair Bleach]], [[Hair Dye]], [[Heptenophos poisoning]], [[Hexachlorobutadiene poisoning]], [[Hyacinth bean poisoning]], [[Imazapyr poisoning]], [[Iodofenphos poisoning]], [[Japanese pagoda tree poisoning]], [[Jessamine poisoning]], [[Jimsonweed poisoning]], [[1,2-Dichloromethane]], [[Cadmium]], [[Degreasing solvents]], [[Dichloroacetylene]], [[Diethylene glycol]], [[Ethylene glycol ethers]], [[Gasoline]], [[Germanium]], [[Glue solvent vapors]], [[Heavy metals]], [[Herbicide]], [[Hexachloro-1,3-butadiene]], [[Hydrocarbons]], [[Lead]],  [[Lantana poisoning]], [[Lead poisoning]], [[Lobelia poisoning]],[[Loquat poisoning]], [[Lupine poisoning]],  [[Mercury]], [[Methanol]], [[Methemoglobin-producing agents]], [[Mayapple poisoning]], [[Mecarbam]], [[Mephenoxalone]],[[Metaldehyde]], [[Methacrifos]], [[Methamidophos]], [[Methaqualone]], [[Methidathion]], [[Methyl Bromide]], [[Methyprylon]], [[Mexican tea poisoning]], [[Nabilone]], [[Naked brimcap poisoning]], [[Omethoate poisoning]], [[Organophosphate insecticide poisoning]], [[Oxydeprofos poisoning]], [[Oxydisulfoton poisoning]], [[Parathion poisoning]], [[Pentachlorophenol poisoning]], [[Phorate poisoning]], [[Phosalone poisoning]], [[Phosdrin poisoning]], [[Phosmet poisoning]], [[Phosphamidon poisoning]], [[Phoxim poisoning]], [[Phthalthrin poisoning]],[[Pirimiphos-methyl]], [[Poison hemlock poisoning]], [[Polyethylene Glycol -- Low Molecular Weight]], [[Primiphos methyl]], [[Profenofos]],[[Propoxur]], [[Prothidathion poisoning]], [[Prothoate poisoning]], [[Pyrimidifen poisoning]], [[Pyrimitate poisoning]],  [[Paint thinners]], [[Paints]], [[Paraquat ochratoxin A]], [[Perchloroethylene]], [[Platinum]], [[Silicon compounds]], [[Silver]], [[Solvents]], [[Styrene]],[[Uranium]], [[Quinalphos poisoning]], [[Quintiofos poisoning]], [[Ramelteon poisoning]], [[Sardine poisoning (clupeotoxin)]], [[Selenious Acid]], [[Slickhead poisoning (clupeotoxin)]], [[Sodium Monofluoroacetate]], [[Sophamide]], [[Sulfotep poisoning]], [[Systemic monochloroacetate poisoning]], [[Tapioca poisoning]], [[Terbufos poisoning]], [[Tetraethyl Pyrophosphate poisoning]], [[Tetrahydrocannabinol]], [[Tetramethrin poisoning]], [[Tetramethylenedisulfotetramine poisoning]], [[Thallium sulfate]], [[Thiometon]], [[Thornapple poisoning]], [[Tolclofos methyl poisoning]], [Toluene]], [[Thallium]], [[Toluene]], [[Trichloroethane]], [[Trichloroethylene]], [[Triazophos poisoning]], [[Triazotion poisoning]], [[Trichloroethane]], [[Triclofos]], [[Triethylene Glycol]], [[Trifenfos]], [[White snakeroot poisoning]], [[Wild cherry seed poisoning]], [[Wild Lima bean poisoning]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[ACTH resistance]], [[Addison's Disease]], [[Diabetic coma]], [[Diabetic ketoacidosis]], [[Functioning pancreatic endocrine tumor]], [[Hyperosmolar non-ketotic diabetic coma]], [[Hyperparathyroidism]], [[Hypoglycemia]], [[Hypothyroidism]], [[Insulinoma]], [[Metastatic insulinoma]], [[Multiple endocrine neoplasia type 1]], [[Multiple endocrine neoplasia type 2]], [[Multiple endocrine neoplasia type 3]], [[Thyroid gland failure]], [[X-linked adrenoleukodystrophy -- Addison disease only]], [[Pituitary apoplexy]], [[Congenital  Hyperinsulinism]], [[Hyperinsulinism due to glucokinase deficiency]], [[Hyperinsulinism due to glutamodehydrogenase deficiency]], [[Pheochromocytoma]] crisis
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Altitude sickness]], [[Comly syndrome]], [[Dehydration]], [[Heat stroke]], [[Hyperbaric sickness]], [[Hypothermia]], [[Mountain sickness]], [[Near-drowning]], [[Suffocation]], [[High altitude cerebral edema]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| End Stage [[Liver Failure]], [[Hepatitis]], [[Progressive familial intrahepatic Cholestasis 2]], [[progressive familial intrahepatic Cholestasis 3]], [[Hepatic encephalopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[2-methylbutyryl-coenzyme A dehydrogenase deficiency]], [[3-methylcrotonyl-CoA carboxylase deficiency]], [[Arginosuccinic aciduria]], [[Carbamoyl-phosphate synthase 1 deficiency]], [[Carnitine deficiency (systemic)]], [[Carnitine transporter deficiency]], [[Citrullinemia I]], [[Citrullinemia II]], [[Congenital  Hyperinsulinism]], [[Flavoprotein deficiency]], [[Fructose-1,6-bisphosphatase deficiency, hereditary]], [[Fructose-1-phosphate aldolase deficiency, hereditary]], [[Fumarase deficiency]], [[Glycine synthase deficiency]], [[HMG-CoA lyase deficiency]], [[Holocarboxylase synthetase deficiency]], [[Hyperinsulinism due to glucokinase deficiency]], [[Hyperinsulinism due to glutamodehydrogenase deficiency]], [[Isovaleric Acidemia]], [[Late onset Argininosuccinase lyase deficiency]], [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]], [[Medium-Chain Acyl-CoA Dehydrogenase Deficiency]], [[Neonatal Argininosuccinase lyase deficiency]], [[Ornithine transcarbamylase (OTC) Deficiency]], [[Fatal familial insomnia]], [[Inborn urea cycle disorder]], [[Methylmalonic  acidemia]], [[Methylmalonic aciduria]] with [[homocystinuria]] and [[cobalamin F]], [[Mitochondrial acetoacetyl-CoA thiolase deficiency]], [[N-acetyl glutamate synthetase deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Antiphospholipid Syndrome]], [[Hemolytic uremic syndrome]], [[Thrombotic thrombocytopenic purpura]], [[Waterhouse-Friderichsen syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| <u>'''Bacterial'''</u>:


[[Ehrlichiosis]], [[Epidemic typhus]], [[Melioidosis]], [[Rocky Mountain spotted fever]], [[Septicemia]], [[Streptococcal Group B invasive disease]], [[Typhoid fever]], [[Vancomycin resistant enterococcal bacteremia]], [[Brain abscess]], [[Cerebellar abscess]], [[Cerebral abscess]], [[Meningitis]], [[Postoperative septicaemia]]
==[[Coma epidemiology and demographics|Epidemiology and Demographics]]==


<u>'''Virus'''</u>:
==[[Coma risk factors|Risk Factors]]==


[[Herpes simplex encephalitis]], [[Meningitis]], [[Arbovirosis]], [[Hendra Virus]], [[HIV/AIDS]], [[Kyasanur-Forrest disease]], [[Lyssavirus]], [[Rabies]], [[Rift Valley Fever]], [[Simian B virus infection]], [[Togaviridae disease]], [[Viral Hemorrhagic Fever]], [[West nile encephalitis]], [[Western equine encephalitis]], [[Yellow fever]], [[HHV-6 encephalitis]], [[Venezuelan equine encephalitis]], [[Western/Eastern/California encephalitis]]
==[[Coma natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


<u>'''Fungus'''</u>:
==Diagnosis==
[[Coma history and symptoms|History and Symptoms]] | [[Coma physical examination|Physical Examination]] | [[Coma laboratory findings|Laboratory Findings]] | [[Coma CT|CT]] | [[Coma MRI|MRI]] | [[Coma other imaging findings|Other Imaging Findings]] | [[Coma other diagnostic studies|Other Diagnostic Studies]]


[[Cryptococcal Meningitis ]]
==Treatment==
[[Coma medical therapy|Medical Therapy]] | [[Coma surgery|Surgery]] | [[Coma primary prevention|Primary Prevention]] | [[Coma secondary prevention|Secondary Prevention]] | [[Coma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Coma future or investigational therapies|Future or Investigational Therapies]]


<u>'''Parasites'''</u>:
== Case Studies ==
[[Coma case study one|Case #1]]
==Related Chapters==


[[Chagas disease]], [[Katayama fever]], [[Malaria]], [[Sleeping sickness (East African)]], [[Sleeping sickness (West African)]], [[Toxoplasmosis]]
* [[Persistent vegetative state]]  
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Acute Disseminated Encephalomyelitis]], [[ADANE]], [[African Sleeping sickness]], [[Alzheimer's disease]], [[Basedow's coma]], [[Bing-Neel syndrome]], [[Brain abscess]], [[Brain cancer]], [[Brain compression]], [[Brain cyst]], [[Brain death]], [[Bristowe's syndrome]], [[Brown-Symmers disease]], [[Cataplexy]], [[Cerebellar abscess]], [[Cerebral abscess]], [[Cerebral hemorrhage]], [[Cerebral metastases]], [[Concussion]], [[Creutzfeldt-Jakob Disease]], [[Cryptococcal Meningitis]], [[Encephalitis]], [[Encephalomyelitis]], [[Epidural haemorrhage]], [[Epilepsy]], [[Fatal familial insomnia]], [[Hashimoto's encephalitis]], [[ Familial type 1  hemiplegic migraine]], [[Hemorrhagic shock]] and [[encephalopathy]] syndrome, [[Hepatic encephalopathy]], [[HHV-6 encephalitis]], [[High altitude cerebral edema]], , [[Hypoxic encephalopathy]], [[Intracerebral hematoma]], [[Jamaican vomiting sickness]], [[Japanese encephalitis]], [[Marchiafava-Bignami disease]], [[Meningoencephalitis]], [[Narcolepsy]], [[Persistent vegetative state]], [[Pituitary apoplexy]], [[Raised intracranial pressure]], Acute [[Spinal cord injury]], [[Stroke]], [[Subarachnoid hemorrhage]], [[Subdural haemorrhage]], [[Traumatic Brain Injury]], [[Vanishing white matter leukodystrophy]], [[Venezuelan equine encephalitis]], [[Western/Eastern/California encephalitis]], [[Westphal-Leyden ataxia]], [[Chagas disease]], [[Herpes simplex encephalitis]], [[Carcinomatosis]] [[meningitis]], [[Catatonia]], [[Hydrocephalus]] 
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Biotinidase deficiency]], [[Hyperglycerolemia-juvenile form]], [[Hyperornithinemia-hyperammonemia-homocitrullinuria syndrome]], [[Inborn amino acid metabolism disorder]], Inborn [[Urea cycle disorder]], [[Leucinosis]], [[Maple syrup urine disease]], [[Methylmalonic  Acidemia]], [[Methylmalonic aciduria]] with [[homocystinuria]], [[cobalamin F]], [[Vitamin B12 unresponsive methylmalonicaciduria]], [[Mitochondrial acetoacetyl-CoA thiolase deficiency]], [[Mitochondrial trifunctional protein deficiency]], [[N-acetyl glutamate synthetase deficiency]], [[Periodic hyperlysinemia]], [[Porphyria]], [[Pyruvate carboxylase deficiency, Group B]], [[Thiamine (Vitamin B1) deficiency]], [[Uremia]], [[Wernicke-Korsakoff syndrome]], [[2-methylbutyryl-coenzyme A dehydrogenase deficiency]], [[3 alpha methylcrotonyl-Coa carboxylase 1 deficiency]], [[3 alpha methylcrotonyl-coa carboxylase 2 deficiency]], [[3-methylcrotonyl-CoA carboxylase deficiency]], [[Arginosuccinic aciduria]], [[Carbamoyl-phosphate synthase 1 deficiency]], [[Carnitine deficiency (systemic)]], [[Carnitine transporter deficiency]], [[Citrullinemia I]], [[Citrullinemia II]], [[Flavoprotein deficiency]], [[Fructose-1,6-bisphosphatase deficiency, hereditary]], [[Fructose-1-phosphate aldolase deficiency, hereditary]], [[Fumarase deficiency]], [[Glycine synthase deficiency]], [[HMG-CoA lyase deficiency]], [[Holocarboxylase synthetase deficiency]], [[Isovaleric acidemia]], [[Late onset Argininosuccinase lyase deficiency]], [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]], [[Medium-chain Acyl-CoA dehydrogenase deficiency]], [[Neonatal Argininosuccinase lyase deficiency]], [[Ornithine transcarbamylase (OTC) Deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Eclampsia]], [[Pregnancy toxemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Brain cancer]], [[Cerebral metastases]], [[Functioning pancreatic endocrine tumor]], [[Insulinoma]], [[Metastatic insulinoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Acetylsalicylic Acid]], [[Amitriptyline]], [[Amlodipine]], [[Antipsychotic drugs]], [[Lorazepam overdose]], [[Atropine]], [[Baclofen]], [[Barbiturates]], [[Benzodiazepine]], [[Bromazepam]], [[Bupivacaine]], [[Buprenorphine]], [[Buspirone]], [[Chlorpheniramine]], [[Chlorpromazine]], [[Cinnarizine]], [[Clonazepam]], [[Clonidine]], [[Clotiapine]], [[Codeine]], [[Colchicine]], [[Tricyclic antidepressant]], [[Cyclobenzaprine]], [[Cycloserine]], [[Dantrolene]], [[Meperidine (patient information)]], [[Deserpidine]], [[Desipramine]], [[Diamorphine]], [[Diazepam]], [[Diphenhydramine]], [[Diphenidol]], [[Disulfiram]], [[Dothiepin]], [[Efavirenz]], [[Eszopiclone]], [[Ether]], [[Ethinamate]], [[Felodipine]], [[Flurazepam]], [[Flunitrazepam]], [[Gabapentin]], [[Ganaxolone]], [[General anaesthesia]], [[Glutethimide]], [[Haloperidol]], [[Heroin]], [[Hydroxyzine]], [[Inhalational anaesthetics]], [[Isoniazid]], [[Isradipine]], [[Acetaminophen]], [[Aminoglycosides]], [[Aminosalicylic acid]], [[Amphotericin B]], [[Aspirin]], [[Bacitracin]], [[Bismuth]], [[Cefaloridine]], [[Chloroform]], [[Chlortetracycline]], [[Cisplatin]], [[Contrast agents]], [[Cyclophosphamide]], [[Cyclosporin]], [[Ibuprofen]], [[Lithium]], [[Methicillin]], [[Neomycin]], [[Nonsteroidal anti-inflammatory drugs]], [[Oxytetracycline]], [[Polymyxin]], [[Prostaglandin synthetase inhibitors]], [[Rifampin]], [[Sulphonamides]], [[Trimethoprim]], [[Levetiracetam]], [[Levomepromazine]], [[Lidocaine]], [[Lofexidine]], [[Lorazepam]], [[Malathion]], [[Medazepam]], [[Meprobamate]], [[Methadone]], [[Methamphetamine]], [[Methyldopa]], [[Metoclopramide]], [[Mianserin]], [[Midazolam]], [[Mirtazapine]], [[Morphine]], [[Nimodipine]], [[Nitrates]], [[Nitrazepam]], [[Nitroglycerin]], [[Nitrous oxide]], [[Nortriptyline]], [[Olanzapine]], [[Opioid]], [[Oxazepam]], [[Oxycontin]], [[Perazine]], [[Percocet]], [[Phencyclidine]], [[Phenelzine]], [[Phenobarbital]], [[Phenothiazine]], [[Pipothiazine]], [[Pizotifen]], [[Pramipexole]], [[Prazepam]], [[Pregabalin]], [[Primidone]], [[Prochlorperazine]], [[Propanol]], [[Propiomazine]], [[Propofol]], [[Quetiapine]], [[Quinidine]], [[Reserpine]], [[Temazepam]], [[Thiopentone]], [[Tizanidine]], [[Tolterodine]], [[Topiramate]], [[Tramadol]], [[Triazolam]], [[Trifluperidol]], [[Vicodin]], [[Vigabatrin]], [[Xanax]], [[Dilaudid]],
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Hysteria]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Anoxemia]], [[Asphyxia]], [[Lung disease]], [[Pulmonary embolism]], [[Respiratory acidosis]], [[Respiratory failure]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Acid-Base Imbalance]], [[Chronic kidney disease]], [[End-stage renal disease]], [[Ddx:Hyperthermia|Hyperthermia]], [[Ddx:Hypocalcemia|Hypocalcemia]], [[Ddx:Hypoglycemia|Hypoglycemia]], [[Ddx:Hypokalemia|Hypokalemia]], [[Hypomagnesemia]], [[Hypoosmolality]], [[Ddx:Hypercalcemia|Hypercalcemia]], [[Ddx:Hyperkalemia|Hyperkalemia]], [[Hypermagnesemia]], [[Ddx:Hypernatremia|Hypernatremia]], [[Hyperosmolality]], [[Hyperphosphatemia]], [[Hypophosphatemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Anaphylaxis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Head trauma]], [[Skull fracture]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Alcohol withdrawal syndrome]], [[Amyloidosis]], [[Anticholinergic syndrome]], [[Electrocution]], [[Fat embolism]], [[Graft-versus-host disease]], [[Malignant Buotonneuse fever]], [[Neuroleptic Malignant Syndrome]], [[Oculoleptomeningeal Amyloidosis]],postoperative [[Hemorrhage]], [[Postoperative septicaemia]], [[Reye's syndrome]], [[Self-induced water intoxication and schizophrenic disorders syndrome]], [[Serotoninergic syndrome]], [[Shaken Baby Syndrome]], [[Streptococcal toxic shock syndrome]], [[Ureterosigmoidostomy]], [[Venomous snake bites]], [[Venomous spider bites]]
|-
|}
 
===In alphabetical order===
 
{{MultiCol}}
* [[1,1-Dimethylhydrazine poisoning]]
* [[1,2-Dichloromethane]]
* [[2-Methyl-4-Chlorophenoxyacetic Acid poisoning]]
* [[2-methylbutyryl-coenzyme A dehydrogenase deficiency]]
* [[3-methylcrotonyl-CoA carboxylase deficiency]]
* [[Acetaminophen]]
* [[Acetone]]
* [[Acetylene poisoning]]
* [[Acetylsalicylic acid]]
* [[Acid-Base Imbalance]]
* [[Ackee Fruit Food poisoning]]
* [[Acrolein poisoning]]
* [[ACTH resistance]]
* [[Acute Chemical poisoning -- Varnish makers' and painters' Naptha]]
* [[Acute Disseminated Encephalomyelitis]]
* [[Acute hemorrhagic leukoencephalitis]]
* [[Acute xylene poisoning]]
* [[ADANE]]
* [[Addison's Disease]]
* [[African Sleeping sickness]]
* [[Aftershave poisoning]]
* [[Alcohol intoxication]]
* [[Alcohol withdrawal syndrome]]
* [[Aldrin poisoning]]
* [[Alicyclic hydrocarbons poisoning]]
* [[Allethrin poisoning]]
* Acute [[altitude sickness]]
* [[Alzheimer's disease]]
* [[Amanita polypyramis poisoning]]
* [[Amidithion poisoning]]
* [[Aminoglycosides]]
* [[Aminosalicylic acid]]
* [[Amiton poisoning]]
* [[Amitriptyline]]
* [[Amlodipine]]
* [[Ammonium Bifluoride]]
* [[Ammonium Sulfamate  poisoning]]
* [[Amphotericin B]]
* [[Amyl Alcohol]]
* [[Amyloidosis]]
* [[Anaphylaxis]]
* [[Anchovy (clupeotoxin) poisoning]]
* [[Aniline poisoning]]
* [[Anoxemia]]
* [[Anticholinergic syndrome]]
* [[Antifreeze poisoning]]
* [[Antiphospholipid Syndrome]]
* [[Antipsychotic drugs]]
* [[Apallic syndrome]]
* [[Apricot seed poisoning]]
* [[Arbovirosis]]
* [[Arginosuccinic aciduria]]
* [[Aristolochic acid]]
* [[Arsenic]]
* [[Asphyxia]]
* [[Aspirin]]
* [[Atropine]]
* [[Azinfos-methyl poisoning]]
* [[Azinphos-ethyl poisoning]]
* [[Azinphosmetile poisoning]]
* [[Azothoate poisoning]]
* [[Bacitracin]]
* [[Baclofen]]
* [[Barbiturates]]
* [[Basedow's coma]]
* [[Benoxafos  poisoning]]
* [[Bentazon poisoning]]
* [[Benzene toxicity]]
* [[Benzodiazepine]]
* [[Beta ketothiolase deficiency]]
* [[Bing-Neel syndrome]]
* [[Biotinidase deficiency]]
* [[Bird cherry seed poisoning]]
* [[Bismuth]]
* [[Bitter almond seed poisoning]]
* [[Black henbane poisoning]]
* [[Black jetbead poisoning]]
* [[Blue-ringed octopus poisoning]]
* [[Boric Acid]]
* [[Box Jellyfish poisoning]]
* [[Brain abscess]]
* [[Brain cancer]]
* [[Brain compression]]
* [[Brain cyst]]
* [[Brain death]]
* [[Brain death]]
* [[Bristowe's syndrome]]
* [[Process Oriented Coma Work]]
* [[Bromazepam]]
==External Links==
* [[Bromide toxicity]]
* [[Bromoform poisoning]]
* [[Brown Recluse spider poisoning]]
* [[Brown-Symmers disease]]
* [[Bupivacaine]]
* [[Buprenorphine]]
* [[Buspirone]]
* [[Butyl Alcohol poisoning]]
* [[Cadmium]]
* [[Camphor]]
* [[Cannabinoids]]
* [[Carbamate insecticide poisoning]]
* [[Carbamoyl-phosphate synthase 1 deficiency]]
* [[Carbaryl]]
* [[Carbinoxamine]]
* [[Carbon monoxide poisoning]]
* [[Carbon Tetrachloride]]
* [[Carbophenothion]]
* [[Carcinomatosis]] [[meningitis]]
* [[Cardiac arrest]]
* [[Carnitine deficiency (systemic)]]
* [[Carnitine transporter deficiency]]
* [[Cataplexy]]
* [[Catatonia]]
* [[Celandine poisoning]]
* [[Cephaloridine]]
* [[Cerebellar abscess]]
* [[Cerebral abscess]]
* [[Cerebral hemorrhage]]
* [[Cerebral metastases]]
* [[Chagas disease]]
* [[Cherry laurel seed poisoning]]
* [[Cherry seed poisoning]]
* [[Chlophedianol toxicity]]
* [[Chloral hydrate poisoning]]
* [[Chlorate salts poisoning]]
* [[Chlorfenvinphos poisoning]]
* [[Chloroform]]
* [[Chloromethane poisoning]]
* [[Chloropyrifos poisoning]]
* [[Chlorpheniramine]]
* [[Chlorpromazine]]
* [[Chlortetracycline]]
* [[Chokecherry seed poisoning]]
* [[Christmas Cherry poisoning]]
* [[Chromium]]
* [[Chromium poisoning]]
* [[Chronic kidney disease]]
* [[Cinnarizine]]
* [[Cisplatin]]
* [[Citrullinemia I]]
* [[Citrullinemia II]]
* [[Clonazepam]]
* [[Clonidine]]
* [[Clotiapine]]
* [[Clupeotoxism]]
* [[Cobra poisoning]]
* [[Cocaine]]
* [[Codeine]]
* [[Colchicine]]
* [[Comly syndrome]]
* [[Common poppy poisoning]]
* [[Concussion]]
* [[Cone shell poisoning]]
* [[Congenital  Hyperinsulinism]]
* [[Contrast agents]]
* [[Copper toxicity]]
* [[Coumaphos poisoning]]
* [[Cresols poisoning]]
* [[Cresylic acid poisoning]]
* [[Creutzfeldt-Jakob Disease]]
* [[Cryptococcal Meningitis]]
* [[Cyanide poisoning]]
* [[Tricyclic antidepressant]]
* [[Cyclobenzaprine]]
* [[Cyclophosphamide]]
* [[Cycloserine]]
* [[Cyclosporin]]
* [[Dantrolene]]
* [[Daphne poisoning]]
* [[Darvocet]]
* [[Ddx:Hyperthermia|Hyperthermia]]
* [[Ddx:Hypocalcemia|Hypocalcemia]]
* [[Ddx:Hypoglycemia|Hypoglycemia]]
* [[Ddx:Hypokalemia|Hypokalemia]]
* [[Ddx:Hyponatremia|Hyponatremia]]
* [[Death Angel poisoning]]
* [[Death Camas poisoning]]
* [[Degreasing solvents]]
* [[Dehydration]]
* [[Demethyldiazepam]]
* [[Demeton-O-methyl poisoning]]
* [[Demeton-S-methyl poisoning]]
* [[Deserpidine]]
* [[Desipramine]]
* [[Devil's trumpet poisoning]]
* [[Diabetes Insipidus]]
* [[Diabetic coma]]
* [[Diabetic ketoacidosis]]
* [[Dialifos poisoning]]
* [[Diamorphine]]
* [[Diazepam]]
* [[Diazinon]]
* [[Dichloralphenazone poisoning]]
* [[Dichloroacetylene]]
* [[Dichloronaphthoquinone poisoning]]
* [[Dichlorvos poisoning]]
* [[Dicrotophos poisoning]]
{{ColBreak}}
* [[Dieldrin poisoning]]
* [[Diethylene glycol]]
* [[Diethylene Glycol poisoning]]
* [[Dilaudid]]
* [[Dimethoate poisoning]]
* [[Dimethyl Phthalate poisoning]]
* [[Dinitrocresol poisoning]]
* [[Dinitrophenol poisoning]]
* [[Di-n-Octyl phathalate poisoning]]
* [[Dioxathion poisoning]]
* [[Diphenhydramine]]
* [[Diphenidol]]
* [[Disulfiram]]
* [[Disulfoton poisoning]]
* [[Dothiepin]]
* [[Eclampsia]]
* [[Efavirenz]]
* [[Ehrlichiosis]]
* [[Electrocution]]
* [[Encephalitis]]
* [[Encephalomyelitis]]
* End Stage [[Liver Failure]]
* [[Endocarditis]]
* [[Endothion poisoning]]
* [[End-stage renal disease]]
* [[English Ivy poisoning]]
* [[English Laurel poisoning]]
* [[Epidemic typhus]]
* [[Epidural haemorrhage]]
* [[Epilepsy]]
* [[Eszopiclone poisoning]]
* [[Ethchlorvynol poisoning]]
* [[Ether poisoning]]
* [[Ethinamate poisoning]]
* [[Ethion poisoning]]
* [[Ethoate-methyl poisoning]]
* [[Ethoprophos poisoning]]
* [[Ethylene glycol ethers]]
* [[Ethylene Glycol poisoning]]
* [[Ethyl-guthion poisoning]]
* [[Etrimfos poisoning]]
* [[Eucalyptus Oil poisoning]]
* [[Fat embolism]]
* [[Fatal familial insomnia]]
* [[Felodipine]]
* [[Fenchlorphos poisoning]]
* [[Fenitrothion]]
* [[Fensulfothion]]
* [[Fentanyl]]
* [[Fenthion poisoning]]
* [[Fire cherry poisoning]]
* [[Flavoprotein deficiency]]
* [[Flurazepam]]
* [[Flunitrazepam]]
* [[Fonophos poisoning]]
* [[Formaldehyde poisoning]]
* [[Formothion poisoning]]
* [[Fructose-1,6-bisphosphatase deficiency, hereditary]]
* [[Fructose-1-phosphate aldolase deficiency, hereditary]]
* [[Fumarase deficiency]]
* [[Functioning pancreatic endocrine tumor]]
* [[Funnel Web spider poisoning]]
* [[Gabapentin]]
* [[Ganaxolone]]
* [[Gasoline]]
* [[General anaesthesia]]
* [[Germanium]]
* [[Glue solvent vapors]]
* [[Glutethimide]]
* [[Glycine synthase deficiency]]
* [[Graft-versus-host disease]]
* [[Hair Bleach]]
* [[Hair Dye]]
* [[Hairdressing sprays]]
* [[Haloperidol]]
* [[Hashimoto's encephalitis]]
* [[Head trauma]]
* [[Heart attack]]
* [[Heart failure]]
* [[Heat stroke]]
* [[Heavy metals]]
* [[Hemiplegic migraine, familial type 1]]
* [[Hemolytic uremic syndrome]]
* [[Hemorrhagic shock]] and [[encephalopathy]] syndrome
* [[Hendra Virus]]
* [[Hepatic encephalopathy]] syndrome
* [[Hepatitis]]
* [[Heptenophos poisoning]]
* [[Herbicide]]
* [[Heroin]]
* [[Herpes simplex encephalitis]]
* [[Hexachloro-1,3-butadiene]]
* [[Hexachlorobutadiene poisoning]]
* [[HHV-6 encephalitis]]
* [[High altitude cerebral edema]]
* [[HIV/AIDS]]
* [[HMG-CoA lyase deficiency]]
* [[Holocarboxylase synthetase deficiency]]
* [[Hyacinth bean poisoning]]
* [[Hydrocarbons]]
* [[Hydrocephalus]]
* [[Hydroxyzine]]
* [[Hyperbaric sickness]]
* [[Juvenile form hyperglycerolemia]]
* [[Hyperinsulinism due to glucokinase deficiency]]
* [[Hyperinsulinism due to glutamodehydrogenase deficiency]]
* [[Hypermagnesaemia]]
* [[Hypernatremia]]
* [[Hyperornithinemia-hyperammonemia-homocitrullinuria syndrome]]
* [[Hyperosmolality]]
* [[Hyperosmolar non-ketotic diabetic coma]]
* [[Hyperparathyroidism]]
* [[Hyperphosphatemia]]
* [[Hypoglycemia]]
* [[Hypomagnesemia]]
* [[Hyponatremia]]
* [[Hypoosmolality]]
* [[Hypophosphatemia]]
* [[Hypothermia]]
* [[Hypothyroidism]]
* [[Hypoxic encephalopathy]]
* [[Hysteria]]
* [[Ibuprofen]]
* [[Imazapyr poisoning]]
* [[Inborn amino acid metabolism disorder]]
* [[Inborn urea cycle disorder]]
* [[Inhalational anaesthetics]]
* [[Insulinoma]]
* [[Intracerebral hematoma]]
* [[Iodofenphos poisoning]]
* [[Isoniazid]]
* [[Isovaleric Acidemia]]
* [[Isradipine]]
* [[Jamaican vomiting sickness]]
* [[Japanese encephalitis]]
* [[Japanese pagoda tree poisoning]]
* [[Jessamine poisoning]]
* [[Jimsonweed poisoning]]
* [[Katayama fever]]
* [[Kyasanur-Forrest disease]]
* [[Lantana poisoning]]
* [[Late onset Argininosuccinase lyase deficiency]]
* [[Lead poisoning]]
* [[Leucinosis]]
* [[Levetiracetam]]
* [[Levomepromazine]]
* [[Lidocaine]]
* [[Lithium]]
* [[Lobelia poisoning]]
* [[Lofexidine]]
* [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]]
* [[Loquat poisoning]]
* [[Lorazepam]]
* [[Lung disease]]
* [[Lupine poisoning]]
* [[Lyssavirus]]
* [[Malaria]]
* [[Malathion]]
* [[Malignant Buotonneuse fever]]
* [[Malignant hypertension]]
* [[Maple syrup urine disease]]
* [[Marchiafava-Bignami disease]]
* [[Mayapple poisoning]]
* [[Mecarbam]]
* [[Medazepam]]
* [[Medium-Chain Acyl-CoA Dehydrogenase Deficiency]]
* [[Melioidosis]]
* [[Meningitis]]
* [[Meningoencephalitis]]
* [[Mephenoxalone]]
* [[Meperidine]]
* [[Meprobamate]]
* [[Mercury]]
* [[Metaldehyde]]
* [[Metastatic insulinoma]]
* [[Methacrifos]]
* [[Methadone]]
* [[Methamidophos]]
* [[Methamphetamine]]
* [[Methanol]]
* [[Methaqualone]]
* [[Methemoglobin-producing agents]]
* [[Methicillin]]
* [[Methidathion]]
* [[Methiocarb]]
* [[Methyl Bromide]]
* [[Methyldopa]]
* [[Methylmalonic  acidemia]]
* [[Methylmalonic aciduria]] with [[homocystinuria]], [[cobalamin F]]
* [[Methylmalonic aciduria]], vitamin B12 unresponsive
* [[Methyprylon]]
* [[Metoclopramide]]
* [[Mexican tea poisoning]]
* [[Mianserin]]
* [[Midazolam]]
{{ColBreak}}
* [[Mirtazapine]]
* [[Mitochondrial acetoacetyl-CoA thiolase deficiency]]
* [[Mitochondrial trifunctional protein deficiency]]
* [[Morphine]]
* [[Mountain sickness]]
* [[Multiple endocrine neoplasia type 1]]
* [[Multiple endocrine neoplasia type 2]]
* [[Multiple endocrine neoplasia type 3]]
* [[Nabilone]]
* [[N-acetyl glutamate synthetase deficiency]]
* [[Naked brimcap poisoning]]
* [[Narcolepsy]]
* [[Near-drowning]]
* [[Neomycin]]
* [[Neonatal Argininosuccinase lyase deficiency]]
* [[Neuroleptic Malignant Syndrome]]
* [[Nimodipine]]
* [[Nitrates]]
* [[Nitrazepam]]
* [[Nitroglycerin]]
* [[Nitrous oxide]]
* [[Nonsteroidal anti-inflammatory drugs]]
* [[Nortriptyline]]
* [[Oculoleptomeningeal Amyloidosis]]
* [[Olanzapine]]
* [[Omethoate poisoning]]
* [[Opioid]]
* [[Organophosphate insecticide poisoning]]
* [[Ornithine transcarbamylase (OTC) Deficiency]]
* [[Oxazepam]]
* [[Oxycontin]]
* [[Oxydeprofos poisoning]]
* [[Oxydisulfoton poisoning]]
* [[Oxytetracycline]]
* [[Paint thinners]]
* [[Paints]]
* [[Paraquat ochratoxin A]]
* [[Parathion poisoning]]
* [[Pentachlorophenol poisoning]]
* [[Perazine]]
* [[Perchloroethylene]]
* [[Percocet]]
* [[Periodic hyperlysinemia]]
* [[Persistent vegetative state]]
* [[Pesticide solvents]]
* [[Phencyclidine]]
* [[Phenelzine]]
* [[Phenobarbital]]
* [[Phenothiazine poisoning]]
* [[Pheochromocytoma]] crisis
* [[Phorate poisoning]]
* [[Phosalone poisoning]]
* [[Phosdrin poisoning]]
* [[Phosmet poisoning]]
* [[Phosphamidon poisoning]]
* [[Phoxim poisoning]]
* [[Phthalthrin poisoning]]
* [[Pipothiazine]]
* [[Pirimiphos-methyl]]
* [[Pituitary apoplexy]]
* [[Pizotifen]]
* [[Platinum]]
* [[Poison hemlock poisoning]]
* [[Polyethylene Glycol -- Low Molecular Weight]]
* [[Polymyxin]]
* [[Porphyria]]
* Postoperative [[hemorrhage]]
* Postoperative [[septicemia]]
* [[Pramipexole]]
* [[Prazepam]]
* [[Pregabalin]]
* [[Pregnancy toxemia]]
* [[Primidone]]
* [[Primiphos methyl]]
* [[Prochlorperazine]]
* [[Profenofos]]
* [[Progressive familial intrahepatic Cholestasis 2]]
* [[progressive familial intrahepatic Cholestasis 3]]
* [[Progressive Multifocal Leukoencephalopathy]]
* [[Propanol]]
* [[Propiomazine]]
* [[Propofol]]
* [[Propoxur]]
* [[Prostaglandin synthetase inhibitors]]
* [[Prothidathion poisoning]]
* [[Prothoate poisoning]]
* [[Pulmonary embolism]]
* [[Pyrimidifen poisoning]]
* [[Pyrimitate poisoning]]
* [[Pyruvate carboxylase deficiency, Group B]]
* [[Quetiapine]]
* [[Quinalphos poisoning]]
* [[Quinidine]]
* [[Quintiofos poisoning]]
* [[Rabies]]
* [[Raised intracranial pressure]]
* [[Ramelteon poisoning]]
* [[Reserpine]]
* [[Respiratory acidosis]]
* [[Respiratory failure]]
* [[Reye's syndrome]]
* [[Rheumatic Fever]]
* [[Rifampin]]
* [[Rift Valley Fever]]
* [[Rocky Mountain spotted fever]]
* [[Sardine poisoning (clupeotoxin)]]
* [[Selenious Acid]]
* [[Self-induced water intoxication and schizophrenic disorders syndrome]]
* [[Septicemia]]
* [[Serotoninergic syndrome]]
* [[Shaken Baby Syndrome]]
* [[Shock]]
* [[Silicon compounds]]
* [[Silver]]
* [[Simian B virus infection]]
* [[Skull fracture]]
* [[Sleeping sickness (East African)]]
* [[Sleeping sickness (West African)]]
* [[Slickhead poisoning (clupeotoxin)]]
* [[Sodium Monofluoroacetate]]
* [[Solvents]]
* [[Sophamide]]
* [[Spinal cord injury, acute]]
* [[Streptococcal Group B invasive disease]]
* [[Streptococcal toxic shock syndrome]]
* [[Stroke]]
* [[Styrene]]
* [[Subarachnoid hemorrhage]]
* [[Subdural haemorrhage]]
* [[Suffocation]]
* [[Sulfotep poisoning]]
* [[Sulphonamides]]
* [[Systemic monochloroacetate poisoning]]
* [[Tapioca poisoning]]
* [[Temazepam]]
* [[Terbufos poisoning]]
* [[Tetraethyl Pyrophosphate poisoning]]
* [[Tetrahydrocannabinol]]
* [[Tetramethrin poisoning]]
* [[Tetramethylenedisulfotetramine poisoning]]
* [[Thallium sulfate]]
* [[Thiamine (Vitamin B1) deficiency]]
* [[Thiometon]]
* [[Thiopentone]]
* [[Thornapple poisoning]]
* [[Thrombotic thrombocytopenic purpura]]
* [[Thyroid gland failure]]
* [[Tizanidine]]
* [[Togaviridae disease]]
* [[Tolclofos methyl poisoning]]
* [[Tolterodine]]
* [[Toluene]]
* [[Topiramate]]
* [[Toxoplasmosis]]
* [[Tramadol]]
* [[Traumatic Brain Injury]]
* [[Triazolam]]
* [[Triazophos poisoning]]
* [[Triazotion poisoning]]
* [[Trichloroethane]]
* [[Trichloroethylene]]
* [[Triclofos]]
* [[Tricyclic antidepressants]]
* [[Triethylene Glycol]]
* [[Trifenfos]]
* [[Trifluperidol]]
* [[Trimethoprim]]
* [[Typhoid fever]]
* [[Uranium]]
* [[Urea Cycle Disorder]]
* [[Uremia]]
* [[Ureterosigmoidostomy]]
* [[Vancomycin resistant enterococcal bacteremia]]
* [[Vanishing white matter leukodystrophy]]
* [[Venezuelan equine encephalitis]]
* [[Snakebite]]
* [[Spider bite]]
* [[Ventricular fibrillation]]
* [[Very low blood pressure]]
* [[Vicodin]]
* [[Vigabatrin]]
* [[Viral Hemorrhagic fevers]]
* [[Waterhouse-Friderichsen syndrome]]
* [[Wernicke-Korsakoff syndrome]]
* [[West nile encephalitis]]
* [[Western equine encephalitis]]
* [[Western/Eastern/California encephalitis]]
* [[Westphal-Leyden ataxia]]
* [[White snakeroot poisoning]]
* [[Wild cherry seed poisoning]]
* [[Wild Lima bean poisoning]]
* [[Xanax overdose]]
* [[X-linked adrenoleukodystrophy -- Addison disease only
* [[Yellow fever]]
* [[Zaleplon]]
* [[Ziconotide]]
* [[Zolpidem]]
* [[Zopiclone]]
{{EndMultiCol}}
 
==Severity==
The severity of coma impairment is categorized into several levels. Patients may or may not progress through these levels. In the first level, the brain responsiveness lessens, normal reflexes are lost, the patient no longer responds to pain and cannot hear.
 
Contrary to popular belief, a patient in a coma does not always lie still and quiet. They may move, talk, and perform other functions that may sometimes appear to be conscious acts but are not.<ref>[http://news.bbc.co.uk/2/hi/europe/6715313.stm BBC NEWS | Europe | Pole wakes up from 19-year coma<!-- Bot generated title -->]</ref>
 
Two scales of measurement often used in [[Traumatic Brain Injury|TBI]] diagnosis to determine the level of coma are the [[Glasgow Coma Scale]] (GCS) and the [[Rancho Los Amigos Scale|Ranchos Los Amigos Scale]] (RLAS). The GCS is a simple 3 to 15-point scale (3 being the worst and 15 being that of a normal person) used by medical professionals to assess severity of neurologic trauma, and establish a prognosis. The RLAS is a more complex scale that has eight separate levels, and is often used in the first few weeks or months of coma while the patient is under closer observation, and when shifts between levels are more frequent.
 
==Outcome==
Outcomes range from recovery to [[death]]. Comas generally last a few days to a few weeks. They rarely last more than 2 to 5 weeks but some have lasted as long as several years. After this time, some patients gradually come out of the coma, some progress to a [[Persistent vegetative state|vegetative state]], and others die. Some patients who have entered a vegetative state go on to regain a degree of awareness. Others remain in a vegetative state for years or even decades (the longest recorded period being 37 years).
<REF>
According to the Guinness Book of Records, the longest period spent in coma was by Elaine Esposito. She did not wake up after being [[Anesthesia|anaesthetized]] for an [[appendectomy]] on August 6, 1941, at age 6. She died on November 25 1978 at age 43 years 357 days, having been in a coma for 37 years 111 days.
</REF>
 
The outcome for coma and vegetative state depends on the cause, location, severity and extent of neurological damage. A deeper coma alone does not necessarily mean a slimmer chance of recovery, because some people in deep coma recover well while others in a so-called milder coma sometimes fail to improve.
 
People may emerge from a coma with a combination of physical, intellectual and psychological difficulties that need special attention. Recovery usually occurs gradually — patients acquire more and more ability to respond. Some patients never progress beyond very basic responses, but many recover full awareness. Regaining consciousness is not instant: in the first days, patients are only awake for a few minutes, and duration of time awake gradually increases.
 
Predicted chances of recovery are variable owing to different techniques used to measure the extent of neurological damage. All the predictions are based on [[statistical]] rates with some level of chance for recovery present: a person with a low chance of recovery may still awaken. Time is the best general predictor of a chance of recovery: after 4 months of coma caused by [[brain damage]], the chance of partial recovery is less than 15%, and the chance of full recovery is very low. <ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15118882&query_hl=5 Clinical predictors and neuropsychological outcome...[Acta Neurochir (Wien). 2004&#93; - PubMed Result<!-- Bot generated title -->]</ref><ref>[http://www.braininjury.com/coma.html brain injury .com | Coma traumatic brain injury - Brain Injury Coma<!-- Bot generated title -->]</ref>
 
The most common cause of death for a person in a vegetative state is secondary [[infection]] such as [[pneumonia]] which can occur in patients who lie still for extended periods.
 
Occasionally people come out of coma after long periods of time. After 19 years in a [[minimally conscious state]], [[Terry Wallis]] spontaneously began speaking and regained awareness of his surroundings. <ref>[http://www.smh.com.au/articles/2003/07/11/1057783356390.html Mother stunned by coma victim's unexpected words - smh.com.au<!-- Bot generated title -->]</ref>
 
A brain-damaged man, trapped in a coma-like state for six years, was brought back to consciousness in 2003 by doctors who planted electrodes deep inside his brain. The method, called deep-brain electrical stimulation (DBS) successfully roused communication, complex movement and eating ability in the 38-year-old American man who suffered a traumatic brain injury. His injuries left him in a [[minimally conscious state]] (MCS), a condition akin to a coma but characterized by occasional, but brief, evidence of environmental and self-awareness that coma patients lack. <ref>{{cite news |title=Electrodes stir man from six-year coma-like state |url=http://www.cosmosmagazine.com/node/1513 |work=Cosmos Magazine |date=02 August 2007}}</ref>
 
==See also==
 
* [[Persistent vegetative state]] (vegetative coma), deep coma without detectable awareness
* [[Brain death]] (irreversible coma), irreversible end of all brain activity
* [[Process Oriented Coma Work]], for an approach to working with residual consciousness in comatose patients
 
==References==
{{Reflist|2}}
 
==Additional Resources==
* BIAUSA (Brain Injury Association of America), [http://www.biausa.org/Pages/types_of_brain_injury.html#diffuse Types of Brain Injury].
* NINDS (National Institute of Neurological Diseases and Stroke), [http://www.ninds.nih.gov/health_and_medical/disorders/tbi_doc.htm public domain information on TBI]
* NINDS (National Institute of Neurological Diseases and Stroke), [http://www.ninds.nih.gov/health_and_medical/disorders/tbi_doc.htm public domain information on TBI]
* NINDS (National Institute of Neurological Diseases and Stroke), [http://www.ninds.nih.gov/health_and_medical/disorders/coma_doc.htm public domain information on coma]
* NINDS (National Institute of Neurological Diseases and Stroke), [http://www.ninds.nih.gov/health_and_medical/disorders/coma_doc.htm public domain information on coma]
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[[Category:Neurology]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]
[[Category:Central nervous system]]
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[[Category:Emergency medicine]]
[[Category:Central nervous system]]

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