Dawaa Reference

Clinical reference

Coma

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Coma - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK430722/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AS53 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · MSF Essential Drugs 2024, GLUCOSE 50% = DEXTROSE 50% injectable · MSF Essential Drugs 2024, NALOXONE injectable

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Signs — what you find (9)

  • A dilated, poorly reactive pupil on one side suggests uncal herniation compressing the third cranial nerve from a mass lesion
  • No focal neurologic findings on exam points toward a metabolic, infectious, or toxic cause rather than a structural one
  • Exam should assess response to pain, motor function, eye opening, speech, and cranial nerves including pupils, corneal, cough, and gag reflexes [cough]
  • The Glasgow Coma Scale scores eye opening, motor response, and verbal response to grade the level of consciousness [coma]
  • Any abnormal posturing seen on exam should be documented
  • Coma is deep unconsciousness with the eyes shut and no response, so both arousal and awareness are gone [coma · loss of consciousness]
  • Lethargy is inattention with only slightly reduced wakefulness, and obtundation is a blunter, less responsive state than that [inattention · lethargy · stupor]
  • Stupor is deeper still: vigorous stimulation rouses the patient only briefly [stupor]
  • Record what the patient actually did when stimulated rather than reaching for a label, because these words are used loosely

Tests (4)

  • Initial labs typically include electrolytes, complete blood count, and a blood gas, plus toxicology testing when indicated
  • CT and MRI of the brain can reveal bleeding, mass effect, or other structural abnormalities
  • Vascular imaging can identify a blocked large blood vessel as the cause
  • EEG should be considered after generalized convulsive status epilepticus when altered mental status persists, since seizure activity can continue with little visible movement

If not this — what else fits (6)

  • Locked-in syndrome mimics coma but the patient is conscious and aware, unable to move or speak except for eye blinks, usually from damage to the pons
  • Minimally conscious state shows intermittent, inconsistent awareness, such as following simple commands or tracking objects with the eyes, which sets it apart from coma
  • Feigned unresponsiveness is revealed by intact caloric testing with nystagmus, or a startle response to a loud sound, pointing away from true coma
  • Coma has many possible causes, including hypoxic brain injury, ischemic or hemorrhagic stroke, brain tumors, hypertensive encephalopathy, low blood sugar, and status epilepticus
  • A brief blackout with a full return to normal alertness is syncope, not coma
  • Low blood sugar is the reversible cause to find and treat before anything else

Scores

  • Glasgow Coma Scale — How depressed is this level of consciousness?

SourceStatPearls "Coma" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Emergency reversal of hypoglycaemia | Suspected opioid overdose

MAIN TREATMENT

1

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

A medical emergency requiring immediate transfer; a GP's only role is a rapid ABC check plus a holding measure (glucose if hypoglycaemic, naloxone if opioid overdose suspected) before urgent transfer. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A medical emergency requiring immediate transfer; a GP's only role is a rapid ABC check plus a holding measure (glucose if hypoglycaemic, naloxone if opioid overdose suspected) before urgent transfer.

Cautions
  • RED FLAG - Airway compromise or respiratory arrest: assess urgently and refer.
  • Referral is the pathway; the medicines listed alongside are what primary care can give before or while it happens.
  • RED FLAG - Any coma is itself an emergency. Unequal or fixed pupils, signs of head trauma, seizure activity, hypoglycaemia on fingerstick glucose, or signs of opioid toxicity (pinpoint pupils, slow breathing) each need immediate emergency management.

EMERGENCY REVERSAL OF HYPOGLYCAEMIA

2

GLUCOSE (DEXTROSE)

Emergency reversal of hypoglycaemia

1st line

Forminjection

Adult dose and duration

50% glucose (500 mg/mL) 1 mL/kg by slow intravenous injection over 3 to 5 minutes

Paediatric dose

Do not use the 50% solution in children - it is too concentrated and irritant. Use 10% glucose at 2 mL/kg by slow intravenous injection; if no ready-made 10% is at hand, 10 mL of 50% glucose added to 100 mL of 5% glucose makes it.

Dose source

MSF Essential Drugs 2024, GLUCOSE 50% = DEXTROSE 50% injectable - verbatim: "Adult: 1 ml/kg by slow IV injection"

Why

Hypoglycaemia is one of the few causes of coma a primary-care doctor can reverse on the spot, and a bedside glucose reading takes seconds.

Cautions
  • Give into a large vein through a large-bore needle and never intramuscularly or subcutaneously - the solution is viscous and causes tissue necrosis if it leaks out of the vein.
  • Recheck the blood glucose after the injection; if it is still low, repeat the dose or give oral glucose depending on how awake the patient is.
  • This treats hypoglycaemia, not coma in general. Give it for a low or unobtainable bedside glucose, not as part of a routine cocktail, and still arrange urgent transfer.
Egyptian brands
Egyptian brandManufacturerIndicative price
DEXTROSE 50% (OTSUKA) I.V. INF. 25 MLOTSUKA3.00 EGP
DEXTROSE 50% (MISR) I.V. INJ. 20 AMP.MISR10.00 EGP
DEXTROSE 50% (OTSUKA) I.V. INF. 500 MLOTSUKA14.20 EGP
DEXTROSE 25% (ALLMED) I.V. INF. 500 MLALLMED MIDDLE EAST10.50 EGP
DEXTROSE 5% (EL NILE) I.V. INF. 500 ML (RUBBER CAP)EL NILE.11.25 EGP
GLUCOSE 5% (OTSUKA) I.V. INF. 1000 MLOTSUKA14.75 EGP
DEXTROSE 5% (MUP) I.V. INF. 500 MLMUP33.00 EGP
GLUCOSE 5% (INTRA PHARM) I.V. INF. 500 ML (EURO CAP + RUBBER STOPPER)INTRA PHARM33.00 EGP

SUSPECTED OPIOID OVERDOSE

3

NALOXONE

Suspected opioid overdose

1st line

Forminjection

Adult dose and duration

1 to 3 micrograms/kg intravenously, repeated every 2 to 3 minutes until the patient breathes adequately; if no vein, 5 to 10 micrograms/kg intramuscularly, repeatable every 90 minutes

Paediatric dose

Children need a higher weight-based dose than adults: 5 to 10 micrograms/kg intravenously, repeated every 2 to 3 minutes until breathing is adequate.

Dose source

MSF Essential Drugs 2024, NALOXONE injectable - verbatim: "Adult: 1 to 3 micrograms/kg by IV injection, repeated if necessary after 2 to 3 minutes"

Why

Pinpoint pupils with a slow respiratory rate in an unresponsive patient point to opioids, and naloxone is the one antidote a clinic can give while waiting for the ambulance.

Cautions
  • Naloxone wears off in 20 to 30 minutes while the opioid does not, so the patient can stop breathing again - keep giving it and keep the patient under observation for hours, never send them home after one ampoule.
  • It supports, and does not replace, assisted ventilation and oxygen.
  • In someone dependent on opioids it can precipitate an abrupt withdrawal syndrome; give the smallest dose that restores breathing.
  • It reverses opioids only and will do nothing for benzodiazepine, alcohol or other sedative poisoning.
Egyptian brands
Egyptian brandManufacturerIndicative price
XEROPIUM 0.4MG/ML 10 AMP.DELTA PHARMA100.00 EGP
RESCUERIX 0.4MG/ML IM/IV/SC 10 AMP.SEDICO > HOPE PHARMA120.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.