Posthypoglycemic coma

Prolonged hypoglycemia, particularly in association with hypoxemia and hypotension, leads to cerebral edema. Recovery may be delayed despite the attainment of normoglycemia, a condition historically termed 'irreversible hypoglycemic coma' but better described as 'post-hypoglycemic coma'. The delay probably reflects the severity of underlying brain damage. In addition to the measures outlined above to restore normoglycemia, additional interventions to reduce cerebral swelling are required, such as head elevation, hyperventilation, high-dose steroids (dexamethasone 8 mg every 6 h), diuretics, and mannitol (0.5-1 g/kg). The prognosis for patients with this condition is varied, with outcomes ranging from complete recovery to persistent vegetative state and death (Z-16 per cent). The only prognostic factor is the duration of coma before attempts at correction.

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