Dr Ira Shah
Consultant Pediatrician, Nanavati Hospital and B.J.Wadia Hospital for Children, Mumbai
Editor - Pediatric Oncall
What is coma?
Coma is a state from which a patient cannot be aroused.
What are the causes of coma?
Coma occurs when there is some toxic or metabolic insult to the brain. The toxin or the metabolic alteration interferes with the function of the brain leading to disturbances in consciousness. Common causes of coma in children are infections such as meningitis or encephalitis TB, low blood sugar (hypoglycemia), head injury, uncontrolled diabetes, drug intoxication, genetic disorders, uncontrolled high blood pressure (hypertensive encephalopathy), bleed in the brain, chronic kidney disease and uremic encephalopathy, deep jaundice and liver failure.
What does the doctor do when or child presents with coma?
The doctor will do a detailed clinical evaluation to determine cause of coma. Doctor will also assess degree of consciousness and determine if there is an immediate risk to life. Depending on the cause suspected and degree of coma, certain blood tests, urine tests, imaging such as CT or MRI of brain may be required. In case of infection, fluid from the brain (cerebrospinal fluid) may be removed and tested for infection. Electroencephalogram (EEG) may be done to determine type of electrical activity in the brain which may help to come to a diagnosis.
What is the treatment for a child with coma?
Doctor will first try and stabilize the patient by ensuring oxygen, normal pulse and blood pressure and making sure patient is breathing well. Intravenous injections of saline and glucose may be given if required. If the patient has fits (seizures), then drugs to control seizures will be administered. If the doctor finds that pressure in the brain (intracranial pressure – ICP) is increasing then drugs to decrease ICP will be administered such as drugs that increase urine output and steroids. Depending on the cause of coma, appropriate treatment will be instituted.
What are the chances of improvement?
That depends on the cause for e.g. coma due to diabetes improves whereas coma due to genetic metabolic disorders may have bad outcome. It also depends on extent of brain damage that has already taken place. It has been found that 75% of comas in children without head injury have a good outcome.
Last Updated On 26/1/2011