# Coma - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - Referral & safety-netting (no drug therapy) - Glucose (dextrose) — injection - Naloxone — injection ## Complete treatment card ```text COMA 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 Review status: REVIEWED against the source listed above (2026-08) 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 Score Glasgow Coma Scale - How depressed is this level of consciousness? Source StatPearls "Coma" - disease-level clinical article Status 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 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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) [1st line] Adult 50% glucose (500 mg/mL) 1 mL/kg by slow intravenous injection over 3 to 5 minutes Peds 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. 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. Caution 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. Egypt DEXTROSE 50% (OTSUKA) I.V. INF. 25 ML OTSUKA 3.00 EGP DEXTROSE 50% (MISR) I.V. INJ. 20 AMP. MISR 10.00 EGP DEXTROSE 50% (OTSUKA) I.V. INF. 500 ML OTSUKA 14.20 EGP DEXTROSE 25% (ALLMED) I.V. INF. 500 ML ALLMED MIDDLE EAST 10.50 EGP DEXTROSE 5% (EL NILE) I.V. INF. 500 ML (RUBBER CAP) EL NILE. 11.25 EGP GLUCOSE 5% (OTSUKA) I.V. INF. 1000 ML OTSUKA 14.75 EGP DEXTROSE 5% (MUP) I.V. INF. 500 ML MUP 33.00 EGP GLUCOSE 5% (INTRA PHARM) I.V. INF. 500 ML (EURO CAP + RUBBER STOPPER) IN... 33.00 EGP SUSPECTED OPIOID OVERDOSE 3. NALOXONE [1st line] Adult 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 Peds 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. 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. Caution 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. Egypt XEROPIUM 0.4MG/ML 10 AMP. DELTA PHARMA 100.00 EGP RESCUERIX 0.4MG/ML IM/IV/SC 10 AMP. SEDICO > HOPE PHARMA 120.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)