Uremic coma: emergency care, intensive care. Features of the development and treatment of uremic coma Uremic uremic coma

Uremic coma - 3

· Reasons - 3

· Symptoms -3

· Pathogenesis – 4

Hepatic coma -5

· Classification and reasons – 5

· Symptoms – 5

· Pathogenesis - 6

Uremic coma or urinary tract develops as a result of endogenous (internal) intoxication of the body caused by severe acute or chronic failure kidney function.

Causes of uremic coma

In most cases, uremic coma is a consequence chronic forms glomerulonephritis or pyelonephritis. Toxic metabolic products are formed in excess in the body, which is why the amount of daily urine excreted sharply decreases and coma develops.

Extrarenal causes of uremic coma include: poisoning medicines(sulfonamide series, salicylates, antibiotics), poisoning with industrial poisons (methyl alcohol, dichloroethane, ethylene glycol), states of shock, uncontrollable diarrhea and vomiting, transfusion of incompatible blood.

In pathological conditions of the body, a disturbance occurs in the circulatory system of the kidneys, as a result of which oliguria develops (the amount of urine excreted is about 500 ml per day), and then anuria (the amount of urine is up to 100 ml per day). The concentration of urea, creatinine and uric acid gradually increases, which leads to the appearance of symptoms of uremia. Due to an imbalance in the acid-base balance, metabolic acidosis develops (a condition in which the body contains too many acidic foods).

Symptoms of uremic coma

The clinical picture of uremic coma develops gradually, slowly. It is characterized by a pronounced asthenic syndrome: apathy, increasing general weakness, increased fatigue, headache, drowsiness during the day and sleep disturbance at night.

Dyspeptic syndrome is manifested by loss of appetite, often leading to anorexia (refusal to eat). The patient experiences dryness and a bitter taste in the mouth, smells of ammonia from the mouth, and increased thirst. Stomatitis, gastritis, enterocolitis are often associated.

Patients with increasing uremic coma have a characteristic appearance - the face looks puffy, the skin is pale, dry to the touch, scratch marks are visible due to unbearable itching. Sometimes you can see deposits of uric acid crystals, similar to powder, on the skin. Hematomas and hemorrhages, pastiness (pallor and decreased elasticity of the facial skin against the background of slight swelling), swelling in the lumbar region and lower extremities are visible.

Hemorrhagic syndrome manifested by uterine, nasal, and gastrointestinal bleeding. There is a disorder in the respiratory system; the patient is bothered by paroxysmal shortness of breath. Blood pressure drops, especially diastolic pressure.

Increasing intoxication leads to severe pathology of the central nervous system. The patient's reaction decreases, he falls into a state of stupor, which ends in coma. In this case, periods of sudden psychomotor agitation may be observed, accompanied by delusions and hallucinations. As the comatose state increases, involuntary twitching of individual muscle groups is permissible, the pupils narrow, and tendon reflexes increase.

Pathogenesis of uremic coma

The first important pathogenetic and diagnostic sign onset of uremic coma – azotemia. In this condition, residual nitrogen, urea and creatinine are always elevated, their indicators determine the severity of renal failure.

Azotemia causes such clinical manifestations like disorders digestive system, encephalopathy, pericarditis, anemia, skin symptoms.

The second most important pathogenetic sign is a shift in water and electrolyte balance. In the early stages, the ability of the kidneys to concentrate urine is impaired, which is manifested by polyuria. At terminal stage renal failure develops oliguria, then anuria.

The progression of the disease leads to the fact that the kidneys lose the ability to retain sodium and this leads to salt depletion of the body - hyponatremia. Clinically, this is manifested by weakness, decreased blood pressure, skin turgor, increased heart rate, and thickened blood.

In the early polyuric stages of uremia development, hypokalemia is observed, which is expressed by decreased muscle tone, shortness of breath, and often convulsions.

At the terminal stage, hyperkalemia develops, characterized by a decrease in blood pressure, heart rate, nausea, vomiting, pain in oral cavity and stomach. Hypocalcemia and hyperphosphatemia are the causes of paresthesia, convulsions, vomiting, bone pain, and the development of osteoporosis.

The third most important link in the development of uremia is a violation of the acidic state of the blood and tissue fluid. In this case, metabolic acidosis develops, accompanied by shortness of breath and hyperventilation.

Hepatic coma– This is the final stage of progressive liver failure. Against the background of severe intoxication of the body caused by pathological or mechanical damage, or the death of a significant part of the liver as a result of injuries, necrosis or when it is removed, as a result of acute and chronic diseases liver, symptoms of severe damage to the central nervous system, as well as other organs and systems, appear.

Classification

According to the main clinical and pathogenetic syndromes, the following are distinguished:

endogenous hepatic coma caused by a sharp decrease in the number of hepatocytes,
exogenous coma associated with intoxication due to “shunting” of portal blood into the general bloodstream,

Endogenous hepatic coma (hepatocellular, true coma, “coma of liver disintegration or replacement”) usually develops when an organ disintegrates, as well as when its parenchyma is replaced by a tumor or scar tissue. Etiological factors are viral hepatitis B, alcoholic and drug intoxication (halothane, chloramphenicol, isoniazid, etc.), acute circulatory disorders (“shock liver”), severe bacterial damage to the liver, etc.

Exogenous hepatic coma(portal-hepatic, ammonia, or “disabled liver coma”) occurs more often than endogenous, usually in patients with portal hypertension syndrome. Its development is provoked by intestinal bleeding, the occurrence of so-called “ascites-peritonitis”, and gross dietary violations, including alcohol intake.

Uremic coma is urinary bleeding that develops as a result of internal poisoning of the body caused by pathologies of the kidneys and its functional failure. At this stage, the tissue contracts so much that it is not able to fully remove toxins from the body.

As a result, they accumulate and intoxication appears. This can lead to hemorrhages in the brain, mucous tissues, and stupor. It all ends in a coma.

Causes

Kidney failure is the main cause of poisoning of the body. The filtration process is disrupted, which leads to intoxication. Urea and creatine remain in the blood, and when they enter the brain, they disrupt consciousness and thinking. An increase in their number leads to circulatory and respiratory disorders.

The disease develops due to incomplete excretion of urine. You can differentiate by:

Stones in the kidneys and bladder.
Cysts.
BPH.
Neoplasms.
Glomerulonephritis.
Diabetes.

Urine stagnates, destroys the membranes of the renal tubules and enters the blood. The phenomenon is rare and occurs with severe pain.

Extrarenal causes:

Infectious diseases of the genitourinary system.
Reaction to medications (sulfonamides, salicylates, antibiotics).
Poisoning by industrial poisons, mushrooms, food.
Incompatibility during transfusion.
Severe vomiting and diarrhea.
Long-term use of alcohol and surrogates.
Anaphylactic shock.
Dehydration of the body.
Hepatic, diabetic syndrome.

Symptoms

Signs of uremic coma come in two forms and have differences:

Acute begins with insufficient fluid secretion (oliguria).

A sharp increase in nitrogen levels in the blood.
In uremic coma, the exhaled air smells of ammonia.
The water-electrolyte balance changes.
Water accumulates.
Heart failure appears (pulse increases, arrhythmia, cerebral edema).

The pathology progresses very quickly. A depressive state sets in, hallucinations and delusions begin. It all ends with the person falling into a coma.

Chronic symptoms increase gradually as kidney cells die.

It begins with dry skin and incessant itching.
Severe headaches.
Visual disorders.
Weakness, fatigue.
Poor night's sleep.
Damage to mucous membranes internal organs(stomach, intestines, heart, pleura).
Bloating, lack of appetite.
Dryness, bitter taste, thirst.
The smell of acetone from the mouth indicates obvious poisoning.
Loss of sodium leads to decreased blood pressure, increased heart rate, and hemostasis.
Lack of potassium provokes muscle spasms, heart pain, swelling of the face and bruises.
Heaviness in the legs and lumbar region.
Nose and uterine bleeding.

Oliguria is replaced by a complete absence of urine flow into the bladder. Poisoning is accompanied by periods of apathy and agitation. Comatosis often occurs with hemorrhagic stroke. The patient becomes indifferent to everything, in a depressed state, and a coma sets in.

Stages

Determined by the level of consciousness disorder:

The patient reacts poorly to stimuli and does not respond. It can be restored with effort.
Soporous – being in deep sleep, when there is practically no reaction to others. You can expect a response only with a painful stimulus.
Total, when there is no reaction, breathing, blood circulation, and metabolism are disrupted.

To determine the depth of the absence of consciousness, they will evaluate:

Opening the eyes.
Speech.
Motor reactions.

Severity of coma:

Moderate from 6 to 8 points.
Deep – 4-5.
Terminal - about 3.

Poisoning affects the liver. Due to impaired kidney function, poisons are in the blood, accumulating and affecting the body. These waste products form encephalopathy. What causes coma is not fully understood. For damage to the liver, lungs, heart and brain, the prognosis is: death.

Features of the course

The clinical picture is almost the same at any time. There is no difference between an adult and a child. Childhood differs in more severe tolerability. They experience:

Fainting and visions.

Lesions of the mucous membranes (ulcers, necrosis).
Heavy bleeding.
Arrhythmia.
Hypertension.
Increase in leukocytes.

Sign of the syndrome: a sharp decline amount of fluid released. A differential approach is inherent in this condition:

Deterioration in performance and attention.
Memory loss and headaches.
Breath smells like acetone.
Deterioration of hearing and vision.

In adulthood, the cause of coma in men is prostate adenoma, in women hormonal imbalance.

The condition is getting worse gradually. The clinic manifests itself in general well-being. You need to be especially attentive to the behavior of children and those patients who have kidney pathologies.

Complications and consequences

The coma is being treated in intensive care. Emergency methods are accepted. The tactics and algorithm of therapy are important. Providing first aid, carrying out intensive measures. The consequences are dangerous for the nervous system. The pathological process that occurs in the body during emergency therapy negatively affects the central nervous system.

After providing assistance and leaving the intensive care unit, the patient notices a deterioration in his condition:

Can't remember recent events.
Memory deteriorates.
Character and thinking change.

If the first signs of poisoning develop, you should call an ambulance to avoid serious consequences. When uremic coma occurs, emergency care is the first thing needed.

Diagnostics

To find out the degree, you need to establish a diagnosis and undergo laboratory tests.

Blood and urine analysis - urea and creatine levels. From their quantity, further conclusions will be determined and additional tests. Your breath may smell like acetone. This is a characteristic sign of the manifestation of pathology.

X-ray of the pelvic organs.

The diagnostic period must pass promptly. The mechanism of the disease is not yet well understood. What exactly causes the pathogenesis has not been established. In the prehospital period, the doctor gives a list medical recommendations, mandatory. Therapy often takes place in a hospital. In severe cases, in the rheumatology department.

Urgent Care

Treatment of uremic coma should be carried out in a hospital. Patients arrive unconscious. At first, the principle of therapy is chosen, round-the-clock care is provided, and the necessary tests are performed. The course of the disease is very serious, time is of the essence. To avoid irreversible processes, you should:

Detoxification. Intravenous medications to normalize urination to remove toxins from the body.
If not high pressure- sodium chloride solution.
Measures are being taken to improve blood circulation.
The stomach and intestines are washed.
Cleansing is underway using hemodialysis.
Plasmapheresis.

The reason for stopping the urine is determined. If it is a stone or tumor, it is removed surgically.

In case of poisoning, contact with the toxic substance should be avoided.

ethnoscience

Herbalists give their treatment methods, which help with rehabilitation and can slow down the formation of uremia.
It is recommended to drink more alkaline mineral water.
Relieve nausea with cold green tea or ice cubes.
Use whey and kefir.
Eat only fruit once a week.
Cramps can be relieved with wet wraps cold water. After wetting the sheet, wring it out. Lay the patient down and cover with a warm blanket.
Among herbs, decoctions of rose hips, St. John's wort, horsetail, and elderberry are useful.

Homeopathy

Among the drugs that inhibit coma and help during rehabilitation can be called barberry, which has an analgesic and anti-inflammatory effect. Helps reduce the amount of salts and remove them from the body.

Pumpkin improves blood circulation.
White hellebore restores nervous system.
Drops based on herbs Galium-Heel.
Ammonia stabilizes the functioning of the heart.
Hydrocyanic acid is needed during agony.

Surgery

The pathophysiological process is different for each patient. The etiology and medical history are different. In some patients, surgery is necessary at some stage. Only a donor kidney transplant is possible. To save the patient's life, this must be done. Other methods surgical treatment No.

Prevention

To avoid coma, take care of your health. You must:

Get annual checkups.
Treat kidney infections promptly.
News healthy image life.
Eat properly.
Do not use antibiotics or other drugs unless prescribed.

Outcome and life expectancy

IN last years Doctors have learned to bring patients out of this state. A patient who has been in intensive care may experience complications that affect the quality of life - memory impairment, cognitive activity, character changes. A fatal outcome cannot be ruled out; it all depends on the degree of the disease. The main thing is to follow the doctor's recommendations.

Uremic coma is the final stage of chronic damage to both kidneys. At this stage, the kidney tissue shrinks so much that it is no longer enough to fully remove toxins. As a result, unnecessary products accumulate in the body, leading to its poisoning.

Hemorrhages in the brain, epidermis and mucous tissues of internal organs may be observed. Then the person falls into a state of stupor. It all ends in a coma.

Long-term chronic kidney diseases are often accompanied by serious complications. One of the most severe pathological conditions requiring emergency medical care, is an azotemic coma. As a rule, it occurs as a result of permanent glomerulonephritis, pyelonephritis, amyloidosis, polycystic kidney disease and other diseases.

Coma is usually diagnosed based on characteristic features long-term kidney damage and the dynamics of disease development. Both are recorded in medical card patient. The patient's comatose state suggests emergency measures to avoid death. First of all, it is necessary to bring the person out of the coma. Urgent measures include life resuscitation important organs(heart and lungs), control of breathing, blood pressure, pulse.

Scientists and doctors are still studying the mechanism of uremia, since its pathogenesis has not been fully traced. It is reliably known that this condition occurs due to:

blood concentrations large quantity protein breakdown products, namely: nitrogenous wastes, urea, creatinine, uric acid;
deterioration of kidney function;
changes in the acid-base balance and mineral structure of the human body.

Under the influence of the above changes in the body, a violation occurs normal operation vital internal organs and systems, therefore azotemic coma is accompanied by severe liver damage and metabolic dysfunction.

The development of kidney failure is usually divided into two stages:

initial or hidden - it can only be detected during a deliberate special examination of the kidneys. It consists in determining the daily indicators of the main characteristics that reflect the activity of the paired organ, its quantitative and speed parameters. These include glomerular filtration, urea clearance, electrolytes, ammonia excretion and others;
the second phase is a certain clinical picture pathological condition. Using a clearance test, a disorder of the filtration and reabsorption function of the kidneys is established. Even a slight excess of the standard indicator signals a violation of the nitrogen-releasing ability of the organ.

It is worth noting that the increase in this indicator in conditions of long-term renal diseases occurs at a slow pace.

Chronic renal failure is systematized depending on the indicators of azotemia and the state of the initial process of urine formation (glomerular filtration). There are three types:

Initial - there is a small amount of retained nitrogen in the blood, namely the content of the substance does not exceed 60 mg; nitrogen-containing carboxylic acid (creatine) – the norm is no more than 3.0 mg; moderate decrease in glomerular filtration.
(A and B) severe, in which the level of nitrogen and creatinine significantly exceeds the norm and a disorder of electrolyte metabolism.
Terminal is an obvious clinical picture of uremia.

Signs of chronic renal failure are manifested in:

disturbances in the normal functioning of all vital organs (dyspeptic disorders). Characteristic indicators: loss of appetite, thirst, feeling of dry mouth, attacks of nausea and vomiting, smell of ammonia from the mouth. Stomatitis, gingivitis and others occur;
formation of pathological processes (neurological disorders). This is a state of restlessness or stupor, seizures, extreme agitation, muscle cramps, motor neuron damage motor nuclei cranial nerves and anterior horns spinal cord, respiratory function is impaired;
damage to the nervous system (trophic disorders), as a result of which the process of cellular nutrition is disrupted, which ensures the preservation of the structure and function of an organ (or its tissue) of neurogenic origin. There is a slowdown in the patient's reactions, as well as a stuporous state, when the patient has a continuous sleep, from which it is quite difficult to wake him up.

As uremia develops, the patient's risk of developing pneumonia and bronchitis increases, and a sudden decrease in vision and hearing is noted. Painful itching of the skin, bleeding, deposition of nitrogenous waste (urea sweat) on the forehead and wings of the nose are additional indicators of a progressive disease. The last stage of uremia ends with the development of terminal endocarditis, which is a harbinger of death.

Features of the course of the disease in adults and children

The occurrence of uremic coma does not depend on age. It occurs in the process of intoxication of the body, kidney dysfunction, destabilization of hormonal metabolism, excessive concentration of poisons resulting from protein metabolism.

This condition is observed in adults and children. The etiology of the disease in both is based on renal failure and its symptoms. First of all, it is an indicator of the volume of urine produced per day (diuresis). Despite the fact that a large amount of fluid is removed from the body, waste products are not completely eliminated and gradually accumulate. Kidney failure leads to the development of acidosis, that is, a shift in the body's acid-base balance towards increased acidity (decreased pH). Both factors, acidosis and azotemia, cause severe poisoning.

Uremic coma is characterized by a gradual increase in all the signs of this condition:

general weakness;
decreased performance and ability to concentrate;
headache;
loss of vision and hearing;
memory loss;
drowsiness;
apathy;
smell of ammonia and so on.

In mature people, uremic coma is caused by:

in men, most often prostate adenoma;
in women it may be a consequence of pyelonephritis, hormonal imbalance or other pathologies of the urinary system.

Children suffer this condition more severely than adults. They often experience:

hallucinations and loss of consciousness;
ulcers and necrosis on the mucous membranes;
increased bleeding;
change in heart tone;
increased blood pressure;
leukocytosis.

The coma state occurs gradually. During this period, the child is lethargic and irritable.

Reasons for the formation of coma

The causes of azotemic uremia are considered to be:

prolonged pyelonephritis;
glomerulonephritis;
intoxication of the body with medications (antibiotics, painkillers, antimicrobial agents);
concentration in the body toxic substances(methyl alcohol, ethylene glycol);
incompatibility of donor blood during transfusion;
constantly occurring bouts of vomiting and diarrhea.

Long lasting pathological process, developing in the kidneys, leads to an increase in oliguria and a reduction in the outflow of urine. Thus, the following occurs: accumulation of urea, uric acids and creatinine, imbalance of acids and alkali in the body, development of metabolic acidosis.

Complications and consequences

When uremic coma occurs, doctors do not give the most favorable prognosis for the patient. The best way to prevent this condition is to identify the disease on its own. early stage. Then the treatment methods will be more effective. Complications, such as pneumonia, worsen the situation. Of particular danger are internal bleeding in the brain and gastrointestinal tract.

The nervous system is subject to serious changes during the period of uremia. After suffering a uremic coma, a person experiences a change in character, his memory suffers, and his cognitive activity is lost. This is a deadly pathology that has an unfavorable prognosis for the patient, so if you have characteristic symptoms, you should consult a doctor.

Diagnostics

To determine the condition and identify the specific factor that provoked the renal coma, first of all, a general clinical blood test is performed. It shows the quantitative content of urea and creatine. Based on these indicators, the direction of treatment is selected.

Ultrasound examination and radiography of the pelvic floor are methods used to determine the source of the disease. These diagnostic methods make it possible to detect the presence of stones in genitourinary system and determine changes in the structure of kidney tissue. In some cases, they carry out computed tomography. Additionally, the indicator of electrolytes in the blood is determined, with the help of which the administration of medicinal solutions is controlled in order to normalize the electrolyte, acid-base balance body.

Treatment and emergency care

A patient in a state of uremic coma is admitted to the intensive care unit. Doctors provide drug and hardware therapy. Medicines, diuretics, saline solutions and glucose are administered intravenously. In especially severe cases, use hormonal drugs. Using special devices, blood purification procedures (hemodialysis and plasmapheresis) are carried out.

Hemodialysis

Emergency procedures:

neutralization of intoxication;
restoration of water and electrolyte balance;
normalization of blood pressure;
with the help of symptomatic therapy, individual especially danger signs coma, such as seizures;
hemodialysis.

The main direction of treatment of the patient’s condition after a coma is to prevent the sources of kidney pathologies that provoke uremia. For example:

performing surgery to remove stones from the kidneys and bladder;
changing your diet and eliminating foods that contribute to the production of ammonia;
limiting close contact with toxic substances.

Prevention

As preventive methods to help avoid the development of uremic coma, doctors recommend:

systematically undergo a medical examination;
heal everything inflammatory processes, occurring inside the body, especially in the organs of the genitourinary system;
carefully undergo a course of treatment for the pathology that led to the formation of renal failure (long-term glomerulonephritis, pyelonephritis, polycystic disease, diabetes, and others).

If kidney failure already exists, then the patient needs to register with a medical institution as early as possible, methodically and systematically treat the disease, following all the specialist’s recommendations. In addition, complications should be avoided surgical operations, bleeding. Normalizing blood circulation in case of insufficiency will significantly reduce the risks of renal coma.

In conclusion, it is worth saying that self-administration of medications without the approval of a doctor can also provoke kidney failure. Therefore, antibiotic drugs, such as Streptomycin, Tetracycline, should be taken only as prescribed by a specialist and under his supervision. The same rule applies to the application antimicrobial agents(sulfonamides), drugs that have a depressant effect on the central nervous system (barbiturates), analgesics and other medications.

Traditional treatment

Alternative medicine, which includes homeopathy and ethnoscience, are quite capable of inhibiting the formation of uremia and limiting the duration of the rehabilitation period.

Traditional recipes:

consumption of alkaline mineral waters and a large amount of liquid;
attacks of nausea are relieved with cold green tea and ice cubes (they should be swallowed after crushing small pieces);
kefir and whey are useful;
convulsions are relieved by wrapping the patient in a damp cloth, soaking it in cold water. Then the person needs to be wrapped in a blanket.
introduce days when the patient eats only fruit. This is effective prophylactic illness;
decoctions of juniper, rose hips, elderberry, horsetail, St. John's wort.

Homeopathy

Homeopathic remedies help stop the course of uremic coma and help restore health, relieving a person of the consequences of the disease:

ammonia is used to stimulate the heart, especially if the urine contains blood, protein, and hyaline casts;
hydrocyanic acid – effective in case of agony during coma;
barberry has analgesic and anti-inflammatory properties, and is also used for a more intensive process of removing fluid from the body. Barberry helps remove excess salts, eliminate deposits and prevent their re-formation;
white hellebore and bitter pumpkin activate blood circulation of organs located in the peritoneum;
the drug Galium-Heel - its action is aimed at reducing the activity of toxins, stabilizing the structure of organs and restoring their functions, promotes stimulation immune system. The product has a positive effect on the tissues of vital organs: heart, liver, kidneys, lungs.

Life expectancy and possible end of coma

Uremic coma does not have any significant effect on the continuation of life. Modern methods resuscitation allows you to bring a person out of this state. However, a fatal outcome cannot be ruled out, but this does not occur often. Subsequently, how long a person will live depends on his compliance with all the doctor’s instructions aimed at preventing the factors that provoke uremia.

It is worth emphasizing that previous uremia can reduce the patient’s quality of life due to a significant impact on his nervous system. The deterioration of a person’s memory and cognitive activity negatively affects his existence in the future.

The final stage of severe kidney damage in acute renal failure (ARF) and irreversible changes in chronic renal failure is uremic coma. ARF occurs with shock, massive blood loss (prerenal form), poisoning with nephrotoxic poisons - acetic acid, mushrooms, medications, toxins of endogenous origin (renal form), with mechanical obstruction urinary tract- tumors, stones in the renal pelvis and ureters (postrenal form).

Pathogenesis of uremic coma

With it, a violation of the urinary and urinary functions occurs. Uremic coma in a child develops from the accumulation of nitrogen metabolic products in the blood and the associated increasing intoxication.

In acute renal failure, the occurrence of hyperazotemia is caused not only by impaired excretory function of the kidneys, but also by increased catabolism of proteins in the body. At the same time, there is an increase in the blood level of potassium and magnesium, a decrease in sodium and calcium.

Causes of uremic coma

Hypervolemia and the osmotically active effect of urea lead to the development of extracellular hyperhydration and cellular dehydration.

In the kidneys, the excretion of hydrogen ions and organic acids is impaired, resulting in metabolic acidosis. Severe disturbances of water-electrolyte metabolism and acid-base balance lead to the development of cardiac and respiratory failure, pulmonary and cerebral edema.

In chronic renal failure, comatose states develop in the terminal stage, when oligoanuria, severe hyperazotemia, metabolic acidosis, cardiac decompensation, edema and swelling of the brain develop.

Uremic coma clinic

Uremic coma develops gradually. A precomatose period is noted. The child becomes lethargic and develops the following symptoms of uremic coma:

Headache, itchy skin, thirst, nausea, vomiting.
Hemorrhagic syndrome: nosebleeds, vomit like " coffee grounds"with the smell of urea, loose stool mixed with blood, hemorrhagic rash on the skin.
Skin dry, pale gray, stomatitis.
The air you exhale smells like urine.
In uremic coma, anemia rapidly progresses, oliguria develops, and then anuria.
Depression of consciousness, attacks of psychomotor agitation, convulsions, auditory and visual hallucinations increase.
Gradually consciousness is completely lost. Against this background, there may be convulsions, pathological forms breathing.
On the skin - deposition of urea crystals in the form of powder.
Auscultation often detects friction noise of the pleura and (or) pericardium.
Arterial pressure increased in uremic coma.
Miosis, nipple swelling optic nerve.
At laboratory research blood is determined: anemia, leukocytosis, thrombocytopenia, high level urea, creatinine, ammonia, phosphates, sulfates, potassium, magnesium.
Decreased sodium and calcium levels, metabolic acidosis.
Low density urine, albuminuria, hematuria, cylindruria.

Emergency care for uremic coma

Treatment consists of detoxification therapy, combating overhydration, correction of electrolyte disturbances and CBS, symptomatic treatment.

For the purpose of detoxification, low-molecular blood substitutes and a 10-20% glucose solution are injected intravenously, the stomach is washed with a warm (36-37 C) 2% sodium bicarbonate solution, and the intestines are cleansed using siphon enemas and saline laxatives. Hemodialysis can be used for: plasma potassium concentrations above 7 mmol/L and creatinine above 800 µmol/L, blood osmolarity above 500 mOsm/L, hyponatremia below 130 mmol/L, blood pH below 7.2, symptoms of overhydration. If a child has a uremic coma, then other methods of cleansing the body can be used:

peritoneal dialysis,
chest drainage lymphatic duct followed by lymphosorption,
ion exchange resins,
intraintestinal dialysis,
hemoperfusion through activated carbons.

Treatment of uremic coma

For low diuresis and hemoglobinuria, a 10% solution of mannitol is prescribed at a dose of 0.5-1 g/kg body weight, furosemide - 2-4 mg/kg body weight, aminophylline - 3-5 mg/kg body weight. In case of anemia, red blood cells are retransfused.

Hyperkalemia is corrected intravenous infusion 20-40% glucose solution (1.5 - 2 g/kg body weight) with insulin (1 unit per 3-4 g of glucose), 10% calcium gluconate solution (0.5 ml/kg body weight), 4% sodium bicarbonate solution (dose is determined by indicators CBS, if it is impossible to determine them - 3-5 ml/kg/weight).

For hypocalcemia and hypermagnesemia it is indicated intravenous administration 10% solution of calcium gluconate or calcium chloride.

For heart failure, inotropic drugs, oxygen therapy, and vitamins are used.

The loss of sodium and chlorine ions during uremic coma is compensated by the administration of a 10% sodium chloride solution, under the control of sodium levels in the blood and urine.

Antibacterial treatment is carried out with caution, taking into account the nephrotoxicity of antibiotics, at half the dose.

Now you know what uremic coma is, why it occurs and how to treat it.