The fact that alcoholism is a disease no one doubts. Treatment of alcoholism is long and complex. Alcoholics die from the diseases to which this dependence leads or from accidents, through carelessness. One of the complications that causes alcohol use is an alcoholic coma.
Worst of all, an alcoholic coma can occur not only against alcoholism, because the toxic effect of alcohol can cause the development of a coma in a low-drinking or a person who drinks only on holidays. Let's look at why there is an alcoholic coma, what is it?
Causes of alcoholic coma
Ethanol or alcohol, affecting the human body, causes alcohol poisoning. Despite the fact that many believe that alcohol can improve mood, it relaxes - this is only the first phase of the action of alcohol. Then comes drowsiness, indifference, and later those brain functions that provide vital processes in the body are suppressed.
Alcoholic coma can occur if the alcohol content in the blood is 3%, this corresponds to severe alcohol poisoning. In some cases, an alcoholic coma can cause even 300-500 ml, drunk in a short period of time. Alcohol is easily absorbed by the mucous membranes, a fifth of the drunk dose enters the blood from the stomach, the rest is gradually absorbed into the intestine.
The development of severe alcohol poisoning is facilitated by:
- lack of food in the stomach (you can not drink alcohol on an empty stomach);
- the amount of alcohol consumed (small doses of alcohol are excreted with sweat, urine, with breathing, 90% of them are decomposed in the liver);
- strength alcoholic beverage (in strong drinks the alcohol content is higher, but drinks with a strength of up to 30% are absorbed into the blood more quickly).
Alcoholic coma develops if the amount of alcohol in the blood is 0.3-0.7 ‰ (ppm), and this is less than 0.5 liters of 96% alcohol, drunk in a short period of time, a person of normal build. Death from alcohol occurs if the blood contains 5-8 g / l of ethanol.
Of course, the reaction to drinking alcohol is different for all people, and this is the most common indicators. There are people who get alcoholic coma and with smaller amounts of ethanol in their blood, while others need to have more. In addition, dense, fatty food slows absorption into the blood and alcohol is excreted earlier than its concentration reaches the deadly.
What is an alcoholic coma? How to determine that a person develops a coma? Alcoholic coma is a condition when a person has a loss of consciousness against the background of taking alcoholic drinks, he does not come to his senses even with strong sound (scream), slaps, smell of ammonia.
With alcoholic coma, the symptoms change as you deepen. There are 3 stages of coma.
- The initial stage of the development of alcohol coma. Consciousness is absent, a person can make some movements in the limbs, but they are messy. Sometimes there are involuntary contractions of the muscles, including the smooth muscles of the stomach (vomiting), the bladder (involuntary urination). Skin of the face is crimson, or bluish. Pupils are narrowed, but there is a reaction to light, sometimes there are floating movements. Breathing is frequent, but hoarse, due to increased secretion of saliva and mucus. The pressure is normal or slightly increased, the pulse is frequent.
- The middle stage of the development of alcohol coma. Excitation decreases, the patient's muscles relax. The pressure decreases, the bullets become slow, weak. The pupils do not respond to light. Breathing slows down, it becomes superficial. Frequence of faeces and urine is observed.
- Deep stage of the development of alcohol coma. It is characterized by an even greater depression of breathing, it becomes rare, disturbances of rhythm and pause are noticeable. This reduces the flow of oxygen into the tissues, and the face acquires a cyanotic shade. The patient is pale, limbs are cyanotic (cyanotic), sticky sweat is released. This is due to the slowing down of the heart, the pulse is poorly felt thread-like, the pressure drops. Infringement of blood supply to organs can lead to changes in the kidneys. Urine becomes dark, brown, can be bloody. This is a symptom of the development of acute renal failure (ARF). But more often the cause of death in this stage is acute cardiac or respiratory failure.
If you find a person with signs of an alcoholic coma on the street, then you need to immediately call an ambulance! Signs of alcoholic coma: lack of consciousness, no reaction to sound, slaps, lent pupils and the smell of alcohol from the mouth.
The first symptoms of an alcohol coma
When an alcoholic coma develops before your eyes, you can notice that after taking a certain dose of alcohol, a person begins to feel dizzy, he is disoriented, does not always understand where he is, confuses the location of rooms in a familiar place, can not find the necessary items. Pale face, weakness, lent pupils, twitching muscles or cramps are the first signs of the onset of an alcoholic coma.
If at this time to help him empty his stomach, causing vomiting, give 5-6 tablets of activated charcoal and lay on one side, then coma, maybe not. The person will sleep. In the morning, of course, will suffer greatly from a hangover. He will have a headache, diarrhea and other dyspeptic phenomena (vomiting, nausea, heartburn) may occur. If there are no violations from the breath and heart, then this condition can be treated at home. It is necessary to provide the patient peace, since strong sounds, light can cause irritation and headache. It is necessary to establish a drinking regime - to drink plenty of water, juices, minerals to quickly remove from the body the products of alcohol exchange. You can drink anesthetic medication.
When the patient has lost consciousness and does not react to others, then urgently call for an ambulance! Of course, the initial stage of alcoholic coma often goes by itself, but it's not worth taking risks. How long does the alcoholic coma last, if there are no violations from the heart and breathing? - it is not difficult to answer - no more than 6 hours. If during this time the patient's reaction to the environment has not changed, then the coma has already passed to the second stage, and intense therapy is required. This is a dangerous condition, so you should not expect a spontaneous withdrawal from the coma, you need to call an ambulance at the first signs.
What should I do before the ambulance arrives? The main danger in the development of alcohol coma - a violation of breathing due to aspiration (getting into the respiratory tract mucus, or vomit), or because of a slippage of the tongue that blocks the entrance to the larynx and interferes with the intake of air into the lungs. Therefore, if there are signs of an alcoholic coma, urgent first aid includes the following actions.
- It is necessary to lay the patient on his left side. In order for his position to be stable, it is necessary to extend his left hand forward and bend his leg in the knee.
- Clear the mouth of vomit. This can be done with the index finger wrapped in a piece of cloth, if there is no clamp and gauze tampons at hand.
- Excess mucus or vomit in the nasal passages, doctors remove the ambulance with the help of suction, but at home in this will help an ordinary syringing.
- In order not to sink the tongue, you can throw back the head and push forward the lower jaw. To do this, press the thumbs of the hands on the corners of the lower jaw, and press the pressure on the chin, slightly opening the mouth. Doctors can use for this language tongue or special air ducts.
- When a patient has convulsions, it is necessary to hold him so that he does not hit on nearby furniture.
First aid for alcoholic coma helps to avoid complications such as aspiration pneumonia. This is a dangerous condition caused by the ingestion of stomach contents during vomiting into the lungs.
There is also another complication - laryngospasm, when vomiting is accompanied by vomiting, the vocal cords contract sharply, and the patient can not breathe. In this situation, an urgent intubation of the trachea - a tracheotomy (cut the skin, subcutaneous tissue and trachea, may be necessary to form a hole with the external medium through which air will flow). This can only be done by a specialist.
Alcoholic coma has a code for the ICD 10 - T51, which means that it is considered a separate disease according to the international classification of diseases.
In order to withdraw a person from an alcoholic coma, the following treatment measures are needed.
Rinse the stomach with a stomach probe to clean water. Rinse the stomach at home, without a probe, is unacceptable, this can lead to aspiration.
- Conduct intensive therapy by intravenous injection of physiological and 5% glucose solutions in a volume of 1.5-2 liters. A 4% solution of sodium hydrogencarbonate, which reduces the acidity of the blood, is also shown. It rises due to the products of alcohol exchange.
- To quickly remove water from the body, enter diuretic ("Furosemide"), you must first put the catheter in the bladder, to track the amount of injected and secreted fluid. This is important to do, since the alcoholic coma is accompanied by hypoxia of the brain (lack of oxygen), which can cause brain swelling with serious impairment of brain activity. Therefore, against the background of intensive administration of solutions, osmotic preparations ("Mannitol") are used.
- The appointment of atropine helps to reduce the excessive formation of saliva and mucus in the lungs, and also supports the work of the heart, without slowing the pulse (bradycardia). The appearance of bradycardia speaks of the deepening of the alcoholic coma.
- The fall in blood pressure can be corrected by vascular means or hormonal drugs.
- Since alcohol decay products disintegrate ethanol, adversely affect the cells of the nervous system, introduce B vitamins, vitamin C, nicotinic acid.
- If there are problems with breathing, or the patient had aspiration of emetics, intubation (insertion of the intubation tube in the trachea), purging of the pulmonary trunk and bronchi with a bronchoscope or suction and artificial ventilation of the lungs. Then the patient is prescribed a course of antibiotics to prevent inflammation of the lungs.
Consequences of alcoholic coma
With timely adequate treatment, the patient leaves the alcoholic coma for 2-4 hours. But even with a favorable current, alcoholic coma causes consequences in the form of bruises and injuries in the fall, headache, memory impairment. Some of the effects of alcohol coma can lead to deterioration of the patient and death.
Acute kidney failure. Occurs when the muscles are squeezed for a long time, under the weight of the body. Myoglobin, which is contained in them, is destroyed and excreted by the kidneys, clogging their tubules. This leads to arresters. Therefore, a person in an alcoholic coma can not be left in one position for a long time, you need to periodically turn it over.
- Inflammation of the lungs on the background of aspiration. The aggressive effect of gastric juice can cause destruction of the lung tissue, and the attachment of infection significantly worsens the prognosis.
- Destruction of cells of the cerebral cortex against the background of alcohol intoxication can lead to a decrease in mental abilities or dementia.
Alcoholic coma is a dangerous condition that can lead to death. At the first signs of coma, call an ambulance, only timely medical assistance, can save a person's life.