Alcohol coma

Coma is one of the most severe conditions that has not been thoroughly studied to date. It is currently unknown what exactly a person feels when falling into a coma, and what can affect its duration.

Alcohol abuse can lead to such serious consequences as alcohol coma.

A toxic dose for the body is considered to be 300-500 ml of alcohol in the blood (depending on the individual characteristics of the body), if the alcohol concentration reaches 1600 ml, severe intoxication begins (vomiting, abdominal pain, loss of consciousness), if it exceeds 1800 ml, a coma develops (blue skin, decreased temperature, noisy breathing).

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Causes alcohol coma

Alcohol coma is the body's reaction to an excessive amount of alcohol in the blood, in other words, the more a person drinks, the greater the risk of severe intoxication and the development of a coma.

It is almost impossible to determine a lethal dose of alcohol; first of all, it depends on the characteristics of the body (for some, intoxication begins after just a few doses, while the body of others, on the contrary, is very resistant to the effects of alcohol).

Also important is the general health of a person - immunity, liver condition or other diseases. Also, drinking alcohol on an empty stomach leads to more severe intoxication and can cause an alcoholic coma.

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Pathogenesis

Alcohol coma can develop within a few hours. The risk of this condition is increased by excessive consumption of strong alcohol, especially when drunk on an empty stomach.

Alcohol disrupts metabolic processes between brain cells, prevents oxygen supply and leads to hypoxia of the brain. This process leads to a decrease in temperature, blood pressure, loss of consciousness, an increase in heart rate, which, along with oxygen starvation, provokes cerebral edema, which causes a comatose state.

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Symptoms alcohol coma

When alcohol is abused, the body can react by completely “switching off” (loss of consciousness), but quite often this condition is not perceived by others as not serious and often the person simply lies down to “sleep it off.”

But loss of consciousness after drinking alcohol can be the beginning of serious disorders in the body, in particular, in the brain.

Doctors note that it is very easy to confuse an alcoholic coma with a stroke; in addition, head injuries can lead to a comatose state.

Doctors distinguish three degrees of alcoholic coma:

• 1st degree (superficial coma) – characterized by loss of consciousness, severe vomiting, salivation, hypertonicity of the extremities, facial skin takes on a blue tint, reflexes are preserved.
• 2nd degree – there is a sharp drop in pressure, breathing slows down, the pulse is barely palpable (an increased rhythm is noted), reflexes disappear, but the reaction to pain remains, at this degree the characteristic symptom is involuntary defecation or urination.
• Stage 3 (deep coma, alcoholic coma) – slow pulse, weak irregular breathing, no response to pain, no reflexes, dilated pupils, skin becomes distinctly bluish. If adequate medical care is not provided, a fatal outcome is possible, most often the cause of death is suffocation by one's own vomit or sunken tongue due to loss of muscle tone. With a high concentration of alcohol in the blood, respiratory arrest or cardiovascular failure may occur.

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First signs

Alcoholic coma is characterized primarily by loss of consciousness, salivation, and blue discoloration of the skin, most often the face and hands.

Complications and consequences

An alcoholic coma can last on average from 7 to 20 days, in rare cases a person can spend years in this state.

Recovery occurs gradually - at first consciousness returns for several hours, over time the person spends more and more time in consciousness.

During the period of being in a comatose state, a number of changes occur in the body, and the consequences largely depend on how well the body copes with such a load, as well as on the degree of coma.

During a coma, damage to the brain occurs, and this can lead to the fact that after coming out of the coma, a person will lose a number of important functions (the ability to walk, speak, move, etc.).

After a stage 1 coma, recovery occurs faster; after stage 3, the brain is almost completely destroyed, so in this case the prognosis is not encouraging.

The most common problems after a person comes out of a coma are memory loss, poor attention, changes in behavior (aggressive state, lethargy, etc.), in some cases relatives and friends stop recognizing the person.

After a comatose state, there is a long-term restoration of everyday skills (independent washing, eating, etc.).

After a coma, a person may have a desire to do something, but stress, especially heavy ones, can significantly worsen their well-being.

Close people should be prepared for the fact that the recovery period will require a lot of effort; the patient needs gymnastics, maintaining personal hygiene, proper nutrition and sleep, walks in the fresh air, regular visits to the doctor, and taking medications.

Complications

Alcoholic coma causes a number of disorders in the body, which can manifest as separate diseases.

First of all, the functioning of the limbs is impaired as a result of swelling, sensitivity and coordination of movements are limited (such disorders can bother for quite a long time).

During a coma, toxins, myoglobin, and protein accumulate in the urine, and renal failure develops, which leads to the urine becoming bloody and brownish-black after a coma.

Alcohol intoxication leads to an increase in the level of urea and nitrogen in the blood.

Also, a coma can lead to muscle atrophy, excess potassium in the body, bleeding of the skin or mucous membranes.

If there is severe intoxication of the body against the background of renal failure, the probability of a fatal outcome increases several times.

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Diagnostics alcohol coma

Diagnosis is based on the main syndrome – comatose state. Information about the circumstances of poisoning is often insufficient or unreliable.

Alcoholic coma is suspected based on the symptoms and characteristic smell of alcohol from the patient (in exhaled air or stomach contents).

During diagnosis, it is important for a specialist to take into account the possibility of a combination of alcoholic and other types of coma: neurological (head injuries, circulatory disorders in the brain are excluded), somatic (with acute hepatitis, diabetes, etc.), toxic (drinking alcohol together with narcotic substances, medications, technical fluids, etc.).

Alcohol consumption often provokes liver and kidney dysfunction, pancreatitis, and diabetic coma.

To identify other possible types of coma, a thorough examination of organs and systems is carried out using ultrasound, X-ray and other methods.

Neurological status is also determined (consciousness, pupils, nausea or vomiting, assessment of muscle strength, pain sensitivity, convulsions, reflexes, etc.), and echoencephaloscopy or lumbar puncture may be prescribed for examination.

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Tests

If an alcoholic coma is suspected, the doctor prescribes a general blood and urine test, biochemical tests (glucose level, amylase, blood clotting time, protein metabolism, etc., if necessary).

To determine the severity of the consequences and the depth of the damage, a blood alcohol level test is prescribed.

If there is no positive effect from treatment after several hours, the coma may be caused by toxic poisoning (simultaneous intake of medications, drugs, technical fluids, etc.) and the treatment tactics should be changed.

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Instrumental diagnostics

In case of alcoholic coma, various methods of instrumental diagnostics may be prescribed, in particular ultrasound (to assess the condition of internal organs – pancreas, liver, kidneys, etc.).

Echoencephaloscopy may also be prescribed (more often in case of head injuries), which is based on echolocation of sagittal brain structures. Diagnostics helps to identify intracranial pathologies, the technique is carried out using sensors that are applied to the side of the head and output information to an external computer.

In unclear cases, a spinal (lumbar) puncture is prescribed (if there is a suspicion of nervous or mental illness, head or back injuries, or vascular diseases).

Differential diagnosis

Differential diagnosis is carried out mainly if alcohol was mixed with medications, narcotics and other toxins.

If there are signs of cerebral circulation disorders, alcoholic coma is diagnosed much more difficultly. In such situations, specialists compare changing neurological data, prescribe laboratory tests, and choose treatment tactics based on this (it is worth noting that in this case there is a high risk of death).

In case of head injuries and circulatory disorders in the brain, a gradual deepening of the coma, an increase in muscle tone, pathological flexion or extension of the toes on only one foot are observed; in addition, the patient may have unevenly dilated (constricted) pupils in the eyes.

Treatment alcohol coma

If an alcoholic coma is suspected, mandatory hospitalization in special toxicology departments is required, where intensive therapy will be carried out.

The principle of treatment is based on blocking further absorption of alcohol into the blood, for these purposes an urgent gastric lavage is prescribed using a probe. The procedure is carried out by inserting a tube into the larynx, which prevents the penetration of liquid and vomiting into the respiratory tract. The lavage is carried out with clean water at room temperature.

To speed up the process of removing alcohol from the blood, a solution of glucose and insulin (20 U of insulin and 0.5 l of a 20% glucose solution), anti-shock (polyglucin, polyvinol), and 0.5 l of physiological solution (to replenish fluid in case of dehydration) are administered intravenously.

Vitamin B6 and B1 (5-6 ml), nicotinic acid (1%, 5 ml) are administered intramuscularly.

In case of acid-base imbalance, which is observed in comatose states, sodium bicarbonate 4% is prescribed (intravenously, up to 1000 ml).

This therapy allows a person to come out of a coma within a few hours.

Alcoholic coma causes disruption of the thermoregulatory center in the hypothalamus, which leads to hypothermia. In this case, rinsing is done with warm water (up to 370C), intravenous solutions are heated to 37-380C, and the patient is surrounded by heating pads.

In case of respiratory failure, the oral cavity is cleaned, a special tube is inserted into the trachea (intubation) and the contents of the upper respiratory tract are sucked out. In case of severe respiratory failure, it is necessary to connect an artificial respiration apparatus; antibacterial therapy is prescribed to prevent aspiration pneumonia, which develops due to vomit entering the lungs.

To restore normal functioning of the cardiovascular system, intravenous administration of plasma-substituting fluids of 500-1000 ml (polyvinol, polyglucin, plasma, hemodez, gelatinol) is prescribed, after which a physiological solution is prescribed to replenish fluid loss. At the same time, the administration of drugs for the heart and blood vessels is indicated:

• cordiamine 5-10ml
• strophanthin 0.05% 0.5ml
• ephedrine 5%, 5-8ml

In case of a sharp drop in pressure, prednisolone 60-90 mg is administered.

All treatment procedures are carried out under the control of water-salt balance, the amount of fluid administered is determined taking into account the daily urine production.

If the patient has signs of muscle damage, a 4% bicarbonate solution is administered intravenously (1500 to 2000 ml per day), a mixture of 10% glucose and 2% novocaine, antibacterial and hormonal drugs, vitamin C, B vitamins, and drugs to support the heart.

To prevent kidney dysfunction, a bilateral novocaine lumbar block is prescribed (abundant injection of novocaine into the nerve endings surrounding the diseased organ), paraffin applications to the lower back.

With low urine acidity, it is necessary to enrich the body with alkali, which helps prevent severe kidney dysfunction. For this purpose, extrarenal blood purification is prescribed artificially.

If the patient is admitted to a small medical facility where it is not possible to carry out the entire range of necessary medical procedures, the main attention is paid to the prevention of respiratory system disorders (for this, the patient must be in a position where the head is lower than the feet), the tongue is fixed with a special clamp, the oral cavity is thoroughly cleaned, and atropine 0.1% (2 ml) is injected under the skin.

After this, the stomach is washed using a tube (while the patient must remain in a head down position).

Urgent Care

First aid for alcoholic coma includes gastric lavage using a tube and intravenous administration of sodium bicarbonate, glucose, and insulin.

Medicines

Alcohol coma is a serious condition that requires a range of treatment procedures.

Drug therapy is aimed at eliminating alcohol intoxication of the body, replenishing the water-salt balance, and normalizing the functioning of all organs and systems.

When administered intravenously, glucose increases the osmotic pressure of the blood, increases the flow of fluid into the blood from tissues, improves metabolic processes in the body and the antitoxic function of the liver, enhances the contraction of the heart muscle, dilates blood vessels, and increases urine output.

Insulin affects carbohydrate metabolism in the body, reduces blood glucose levels, improves its penetration into cells, and blocks the conversion of fats and amino acids into carbohydrates.

Plasma substitutes and anti-shock drugs:

• Polyglucin is prescribed to prevent acute blood loss, in severe intoxications. The main substance of the drug - dextran - helps to replenish blood volume, prevents the adhesion of red blood cells and platelets.
• Polyvinol is used for intoxications and bacterial shock. The drug has an effective detoxifying effect, is excreted from the body in a short time, while absorbing and removing toxins.
• Rheopolyglucin (analogue of polyglucin), has a disaggregating effect (reduces the risk of thrombosis), is prescribed in severe shock conditions to preserve the functions of vital organs. Contraindicated in heart failure, decreased amount of urine excreted by the kidneys, decreased platelet levels.
• Hemodes neutralizes foreign substances (including a number of drugs), toxins of pathogenic microorganisms, etc., absorbing them from the blood, reduces the risk of thrombus formation, eliminates the arrest of red blood cells in capillaries, and enhances blood circulation. Contraindicated in bronchial asthma, acute nephritis, and cerebral hemorrhages.
• Gelatinol has a weaker effect compared to polyglucin, but effectively stabilizes blood flow through the vessels. The drug is non-toxic, does not increase sensitivity, does not accumulate in the body, does not change the structure of red blood cells and blood composition.

Not prescribed for acute kidney pathologies.

In large doses (up to 3 liters) it interferes with normal protein metabolism, leads to a decrease in osmatic pressure in the intercellular space, and increases the risk of tissue hypoxia.

Cardiovascular drugs:

• Ephedrine stimulates the heart, increases the force and frequency of contractions, increases blood pressure, increases the tone of skeletal muscles, increases the sugar content in the blood serum. Contraindicated in high blood pressure, tachycardia, myocardial disease, tumors that secrete catecholamines.
• Cordiamine is an analeptic, stimulates the central nervous system, has a stimulating effect on the vasomotor and respiratory centers, and stimulates the heart. Its mechanism of action is similar to camphor, caffeine, and corazol. Contraindicated in epilepsy and convulsions.
• Strophanthin (short-acting cardiac glycoside) increases the strength and frequency of myocardial contractions, which causes an increase in stroke and minute volume of blood and reduces the myocardium's need for oxygen.
• Prednisolone increases blood glucose levels, enhances the reabsorption of water and sodium, and has a pronounced anti-inflammatory effect. Contraindicated in case of hypersensitivity to the drug, fungal infections.

Folk remedies

Alcoholic coma is a serious condition that requires urgent hospitalization of the patient. Treatment of this condition with folk medicine is practiced, but some recipes of folk healers will help the body to recover faster after a coma.

Rose hips gently cleanse the liver and blood.

Cabbage juice reduces liver pain and replenishes vitamin deficiencies in the body.

Lingonberries and currants are often recommended for use in cases of any intoxication; they contain a large amount of vitamins and microelements that are necessary for normal liver function.

Cranberries, despite the skepticism of traditional medicine, have long been used by people to treat liver diseases; it is recommended to consume 1 teaspoon of cranberries, ground with honey, before meals to normalize liver function and improve the condition of the body.

Black radish juice and honey promotes gentle cleansing of the liver (0.5 l of juice and 200 ml of honey, take 2 tbsp. 2 times a day).

Citrus juices help liver cells to recover, they contain many vitamins, especially vitamin C, which helps the liver remove toxins.

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Herbal treatment

Among the herbs, the most suitable for restoring the liver after alcohol intoxication are immortelle, artichoke, knotweed, milk thistle, and St. John's wort.

Herbal treatment is mainly carried out after a person comes out of a coma to restore the functions of internal organs, improve overall health, and replenish vitamins.

Alcoholic coma leads to disruption of a number of vital functions of the body, especially severe consequences are observed in the functioning of the central nervous system.

Collections of medicinal herbs after alcohol intoxication:

1. Birch buds, St. John's wort, immortelle, chamomile - 100 g each. Pour 1 tbsp of herbal mixture into 0.5 l of boiling water, leave for 15 minutes, strain. Drink half of the resulting infusion before bed (you can add 1 tsp of honey), the second part in the morning. The course of treatment is at least a month. The infusion helps to improve metabolism, cleanse blood vessels, remove toxins, improve vision, and normalize weight.
2. Mint leaves, immortelle (3 tbsp each), dill seed (1 tbsp). Pour 400-500 ml of boiling water over 1 tbsp of the mixture, leave for half an hour, drink warm half an hour before meals. The course of treatment is 2 months.

Homeopathy

Homeopathy is considered an alternative method of treating alcohol addiction.

Alcohol coma is a condition caused by poisoning of the body with ethyl alcohol, homeopathic medicines will help reduce the craving for alcohol and prevent the onset of such severe consequences as alcohol intoxication or coma.

The most famous remedy among homeopaths that helps to overcome the painful craving for alcohol is Proproten 100, which contains extremely low doses of antibodies to the protein, which is the main regulator of the nervous activity of the brain. The drug is effective in mild and moderate alcohol addiction, it affects the main areas of the brain, normalizes its functions, helps to reduce excitability, anxiety, relieve mental stress, painful craving for alcoholic beverages. The drug also relieves headaches, weakness, improves the functioning of the digestive organs and removes other symptoms characteristic of the "hangover" syndrome.

The drug should be taken no earlier than 6 hours after the last intake of alcohol, 20 minutes before meals.

In the first two hours from the start of taking the medicine, you need to drink 5-10 drops or dissolve 1 tablet every half hour, then every hour.

After about 10 hours, when the patient’s condition improves, the drug is taken every 2-3 hours (4-6 tablets per day).

Taking the drug may cause short-term double vision, which does not require additional treatment. In rare cases, allergic reactions occur.

Proproten 100 should be taken with caution with sleeping pills.

Before starting treatment, a consultation with a narcologist is required.

Surgical treatment

Alcohol coma is associated with poisoning of the body with ethyl alcohol and the basis of treatment is the removal of alcohol from the body by means of gastric lavage, which must be done only in a medical facility using a tube.

Patients in alcoholic coma are not subject to surgical treatment.

Prevention

Alcohol coma is a consequence of poisoning the body with ethyl alcohol, to prevent such a condition it is necessary not to drink any alcoholic beverages on an empty stomach (absorption into the blood in this case is several times higher), not to drink large doses of alcohol, not to drink if you have any gastrointestinal diseases, during a diet, or if you are overtired.

It is also contraindicated to consume alcohol simultaneously with any medications.

It is not recommended to mix different alcoholic drinks (or drink them in ascending order of strength), and also to eat well after each dose of alcohol.

The best prevention of alcohol poisoning and other serious consequences associated with alcohol consumption is complete abstinence from alcohol.

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Forecast

With timely medical care, the likelihood of a favorable prognosis for a condition such as alcoholic coma is quite high.

If the victim is sent to the hospital in time, where he receives competent assistance, his condition will improve within a few hours.

If a person is in a coma for more than a day, the chances of a positive outcome are significantly reduced, especially if severe symptoms are observed (low blood pressure for a long time, arrhythmia, uneven breathing, etc.).

Alcohol coma is a serious condition caused by ethyl alcohol poisoning. This condition is often the result of prolonged alcohol consumption in large doses, when the body can no longer cope with toxins and simply "switches off".

The condition is quite severe and can lead to death or disability, but timely competent medical assistance will help return a person to a full life. After coming out of a coma, a person needs help from loved ones, as well as specialized help to cope with the painful craving for alcohol and return to normal life.

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