Hôn mê Coma (bắt nguồn từ cùng một từ trong tiếng Hy Lạp có nghĩa là "sâu ngủ'') là một trạng thái" bất tỉnh sâu sắc mà từ đó người ta không có thể được khuấy động [1] "etiologies có liên quan cho nhà nước này bao gồm các rối loạn về mức độ bất thường của natri | 904 BAZAKIS KUNZLER for the lethargic state does not necessary complete the list of possible comorbid sources for the patient s lethargic state. Coma Coma derived from the same word in Greek meaning deep sleep is a state of profound unconsciousness from which one cannot be roused 1 . Relevant etiologies for this state include disorders of abnormal levels of sodium calcium magnesium phosphate and potassium and porphyria Wenicke s disease and myxedema coma from profound hypothyroidism. Further discussion of these endocrine and metabolic disorders is found elsewhere in this issue. Of note while disease states such as Wernicke s disease are not classified typically as a metabolic disorder the correction of this thiamine deficiency only will reverse the resultant coma if the magnesium deficiency a necessary cofactor in the metabolism of thiamine is repleted. Coma can be a supratentorial manifestation of hypomagnesemia by itself 12 . Uncontrolled diabetes also can lead to hyperosmolar hyperglycemia resulting in coma. In fact severe hyperosmolar hyperglycemia has been noted by at least one author to be the most frequent cause of an altered state of consciousness in patients with uncontrolled diabetes. Often these patients are chronically ill and have depleted stores of potassium phosphate and magnesium 13 14 . Seizure Seizures convulsion an epileptic fit 1 are less typically related to metabolic or endocrine disorders but they indicate a high level of severity. For purposes of this discussion the term seizure is considered synonymous with the tonic-clonic formerly known as grand mal type of seizure. Relevant etiologies for this condition include hypernatremia or its rapid correction hyponatremia hypercalcemia hypocalcemia hypomagnesemia thyrotoxicosis pyridoxine deficiency pellagra and hypoglycemia. The emergency physician should be aware of not only the typical electrolyte abnormalities but also the secondary causes. For example the teenage patient seizing in the .
