Coma in renal failure. Uremic coma: clinic, diagnosis, emergency care

A condition in which a pathological process occurs in the kidneys. At the same time, an extremely serious condition develops. Uremic coma is a pathological condition due to renal failure.

There may be a profound loss of consciousness. The immediate cause of this condition is acute and chronic renal failure. Renal failure manifests itself quite acutely. The process of urination is disturbed.

What exactly is the process? The process is mainly associated with insufficient filtration of urine by the kidneys. At the same time, metabolic products remain in the blood. During normal functioning, all metabolic products are removed from the blood.

Metabolic products go directly to the brain. There is a pathological process. This process is characterized by a disorder of thinking and consciousness. If a uremic coma develops, then loss of consciousness occurs.

With loss of consciousness, blood circulation and respiration are disturbed. However, this process is partial. And this process is caused directly by the ingress of metabolic products into the brain.

The consequence of uremic coma is renal failure. There are also other reasons for the development of this condition. The most common causes of uremic coma are:

pyelonephritis;
glomerulonephritis;

All these kidney diseases, one way or another, lead to uremic coma. Especially if there is no proper medical therapy. In addition, conditions such as kidney stones matter.

But usually these conditions lead to various pathological disorders. There are sharp pains. Often the patient goes to the doctor with acute pain in the pubic area.

Intoxication of the body often leads to the development of uremic coma. Most often, intoxication is caused by severe poisoning. These poisonings usually occur when exposed to benzene, lead.

In the clinical manifestations of uremic coma, the state of the ancestral coma is of great importance. That is a direct uremic factor. This factor leads to the development of pathological conditions.

Symptoms

The clinic of uremic coma is diverse. Mostly coma is manifested by a lack of consciousness. The following symptoms are also of great importance:

clouding of consciousness;
dizziness;
excitation;
oppression of consciousness;

The most significant sign of uremic coma is a certain smell from the mouth. Mostly the smell of urine. But coma is accompanied by the presence of respiration and pulse on the carotid and radial arteries.

Coma is not fatal, but carries with it various adverse effects. Which is kidney failure. In any case, it is necessary to provide the patient with urgent medical care.

This condition often resembles delirium. But the only sign of uremic coma, unlike delirium, is a sharp smell of urine from the mouth. In this case, the smell can be felt from a distance.

The presence of reflexes from the cornea of the eyes also indicates the pathological condition of the patient. In this case, the action of stimuli leads to a narrowing of the pupil. And this factor also speaks of a coma.

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Diagnostics

How can this condition be diagnosed? Uremic coma should be diagnosed immediately. Otherwise, a large expiration of time will lead to irreversible consequences.

They take blood directly for analysis. In order to determine the overall analysis and measurement of urea and creatinine. Usually uremic coma is accompanied by an increased content of these metabolic products.

It is the presence of elevated levels of urea and creatinine that indicates the disease. This is a significant indicator for a more accurate diagnosis. Of great importance is the diagnosis of possible causes of uremic coma.

An additional diagnostic method is an ultrasound examination. Predominantly ultrasound diagnostics of the kidneys. As well as radiography of the pelvic organs.

Diagnosis of the causes of uremic coma will help determine the diagnosis. Ultrasound diagnosis allows you to determine various renal abnormalities. Let's say .

Urolithiasis is determined. Since often the presence of kidney stones leads to disruption of the functioning of the urinary system. The most necessary and demonstrative study is tomography.

Assign a specific therapeutic therapy. Predominantly prescribed infusion of infusion solutions. For this therapy, the level of electrolytes in the blood is determined.

Prevention

To prevent the development of uremic coma, it is necessary to cure various diseases in a timely manner. Which is renal pathology. As well as other disorders in the pelvic organs.

It is advisable to consult a specialist. This avoids the development of a state of uremic coma. The urologist will tell you about the need for preventive measures.

Monitor the pathological process in the kidneys. It is preferable to undergo ultrasound diagnostics. This helps to prevent the development of coma. It is also necessary to conduct a study of the prostate.

Since it is prostatitis that can lead to a state of uremic coma. should be treated in time to avoid serious consequences. If uremic coma is caused by intoxication of the body, then it is important to adhere to the following rules:

do not take drugs that can cause an allergic reaction;
do not eat foods that are not fresh or contain an allergen;
do not come into contact with chemicals hazardous to life

If a person works in a hazardous industry, it is better to avoid contact with harmful substances. Which are various chemical compounds. If food poisoning occurs, it is imperative to rinse the stomach.

Treatment

If, nevertheless, this serious condition has happened to you, then it is necessary to resort to certain therapeutic measures. In this case, drug therapy and hardware are prescribed. There may be folk remedies for the treatment of uremic coma.

Drug therapy is aimed at the infusion of a large amount of fluid. Mostly by intravenous infusion. Use saline solution. Diuretics are used.

Diuretic drugs are needed to expel metabolic products from the blood. Lasix and furosemide are widely used. But these drugs are best used in a hospital setting. Since they are injected directly into a vein.

It is necessary to take measures to promote blood thinning. Namely, means that prevent blood clotting are used. In this case, a well-known remedy is used - heparin.

If the condition is most severe, then hormonal drugs may be used. such as prednisolone and dexamethasone. It is advisable to apply surgical intervention.

Surgical intervention is necessary in case of formation of a tumor or prostate adenoma. With urinary retention, bladder catheterization is used. Hardware therapy is aimed at cleansing the blood of decay products.

The hardware method in the treatment of uremic coma is associated with the use of hemodialysis. At the same time, the blood is cleansed not only from decay products, but also from toxins. Which leads to an improvement in the patient's condition.

In adults

Uremic coma in adults can be caused by various pathological processes. For example, in men, a coma develops due to prostate adenoma. This is the most common cause of the disease.

Prostate adenoma is a fairly common occurrence. At the same time, it is advisable to carry out some therapeutic measures to cope with the disease. For women, the reasons are varied.

Uremic coma in adults can develop at any age. If it is a consequence of pyelonephritis, then it proceeds quite sharply. Medical assistance is urgently needed.

What therapeutic measures should be taken? Not only the lifestyle of the patient, but also nutrition should be adjusted. In addition to drug treatment methods, the patient's diet is widely used. In this case, preference is given to plant foods.

You should also include fruits in your diet. As an essential source of vitamins. It is better to exclude protein foods. Or at least reduce it in quantitative composition.

Alternative treatment of uremic coma should be aimed at rehabilitation after this condition. It is impossible to get out of a uremic coma by folk remedies. Any adult should know about this.

In children

Uremic coma in children develops gradually. At the same time, symptoms such as nausea, vomiting, itching and thirst develop. Already in the presence of these symptoms, it is necessary to sound the alarm.

In children, the symptoms are varied. In this case, hemorrhagic syndrome matters. What then happens? Children have the following conditions:

nose bleed;
loose stools with an admixture of blood;
hemorrhagic rash on the skin

\ At the same time, the skin is dry. Stomatitis may develop. Anemia quickly develops in children. From the side of the central nervous system, these conditions are observed:

oppression of consciousness;
convulsions;
hallucinations

Diagnosis of uremic coma includes various studies. Anemia is observed. That is, directly in the blood tests. Anemia leads to various pathological processes.

A child with anemia becomes lethargic. There is dizziness and pallor. Help with uremic coma comes down to the following activities:

intravenous administration of blood substitutes;
gastric lavage;
diuretic drugs;
saline;
oxygen therapy;

Oxygen therapy is advisable to carry out in heart failure. Vitamins are also used to maintain the normal functioning of the cardiovascular system. Antibacterial therapy is carried out with caution.

Forecast

In uremic coma, the prognosis depends on the presence of complications. Only timely treatment of this condition will avoid uremic coma. This means that the prognosis will be favorable.

The prognosis is unfavorable with untimely assistance. And also with the development of certain complications. Much depends on the etiology of the disease.

If the treatment is aimed at combating the underlying disease, then the prognosis is more likely to be favorable. Since it is this technique that allows you to come to an improvement in the patient's condition. Which is not uncommon in this case.

Exodus

In this condition, death is possible. However, timely provision of assistance usually does not lead to such outcomes. A complication of this condition is often the development of renal failure.

There is also the development of deviations from the nervous system. A person may experience a decrease in memory and thinking. It does not lead to death. But it leads to a direct decrease in the quality of life.

Uremic coma may end in recovery. But it is necessary to use complex treatment. It should consist in the introduction of drug and hardware therapy.

Lifespan

In uremic coma, life expectancy may not decrease. The patient can be brought out of this state. But no small effort should be made. Often, surgery is required.

With surgery, life expectancy may not be reduced. Especially if the tumor is removed. However, the consequences of removing tumor formations can be different.

Life expectancy is higher if the patient follows certain medical recommendations. Especially during the recovery period. This helps to prevent the recurrence of this condition.

Uremic coma occurs on the basis of severe intoxication of the body with a variety of kidney diseases. In a normal state, all metabolic products are excreted by the kidneys with urine, during a coma, intoxication with non-excreted metabolic products gradually increases. Uremic coma is a serious condition, the last stage of many kidney diseases. Without timely qualified treatment, death can occur.

Main causes and predisposing factors

With serious violations in the work of the kidneys, blood circulation in them worsens. Oliguria occurs next, that is, the amount of urine output can be no more than 500 ml per day. The concentration of toxins in the blood continues to increase, creatine and uric acid increase, a serious condition occurs - uremia. At the same time, the volume of urine excreted from the body is not more than 100 mg per day. Acidic foods accumulate more and more and metabolic acidosis occurs.

There are also extrarenal causes of the development of uremic coma, these are:

poisoning with drugs (for example, antibiotics or salicylates), industrial poisons (for example, dichloroethane or methyl alcohol), poisonous mushrooms, alcohol, poor-quality food;
dehydration;
acute anaphylaxis;
severe viral infections.

Contributes to the development of uremic coma regular consumption of any alcoholic beverages.

Clinical manifestations and symptoms

Before the onset of uremic coma, the patient has many different abnormalities that can last up to several years. Initially, this is a decrease in the volume of urine, a change in its color (becomes lighter), excretion of urine to a greater extent at night, and not, as expected, during the day.

If such urine is taken for analysis, it turns out that its specific gravity is quite low. When examining the blood of such a patient, it is found that there is a lot of residual nitrogen in the analysis.

Biochemical abnormalities in the human body lead to the following symptoms:

anemia;
painful condition;
the occurrence of frequent headaches;
jumps in blood pressure;
the occurrence of puffiness and swelling of the lower extremities, face;
frequent nausea and urge to vomit;
deterioration and complete loss of appetite;
change in stool (mainly diarrhea);
dry mouth;
emaciation.

The chair can be not just constantly liquid, but with impurities of mucus and blood clots. Diarrhea develops due to the excretion of a large amount of nitrogenous wastes by the intestines. Also often there is pain in the stomach, which may indicate the appearance of hemorrhagic gastritis, and in the terminal stage - colitis.

Urea begins to be excreted along with saliva, which causes an unpleasant pungent odor from the mouth, as well as skin pores. In the last stage of uremia, urea crystals can be seen on the skin, they are especially noticeable in the skin around the nose.

Residual nitrogenous formations also affect the bone marrow, anemia appears. Anemia causes hemorrhagic diathesis, which is expressed by a decrease in the supply of blood vessels. Hence frequent headaches, weakness, dizziness, pressure surges and other unpleasant symptoms.

Uremic intoxication causes muscle twitches, convulsions. The nervous system responds to the development of uremic coma with a respiratory disorder that becomes noisy, superficial, and hard.

Another symptom of the development of uremic coma is a narrowing of the field of view, a drop in visual acuity, and constriction of the pupils.

A decrease to 35 degrees of the total body temperature indicates the development of the terminal stage of uremic coma. The temperature can be below 35 degrees, everything is individual. In the terminal stage, hyperkalemia develops, blood pressure decreases significantly, the heart rate slows down, abdominal pain increases with nausea and vomiting. Paresthesia, hyperventilation may occur.

Stages of uremic coma

They are classified according to the degree of impairment of consciousness:

1st stage. Contact with the patient is possible, but his responses are inhibited or completely absent.
Stage 2. At this stage, the patient practically does not wake up, as he sleeps all the time. You can wake him up only with the help of a painful stimulus.
3rd stage. It is characterized by an absolute loss of consciousness.

There are 3 degrees of severity of pathology: moderate, deep and terminal. In the terminal stage, brain death occurs. This is a state from which it is impossible to get the patient out.

Complications and outcome

Even acute uremia with timely treatment can be eliminated (using hemodialysis). Sometimes it takes six months to recover, sometimes more than a year.

The chronic course of the disease can last a very long time, but constant intoxication will cause various complications in the heart, brain, all organs and systems of the body.

With constant medical supervision, complex timely treatment, the prognosis is favorable. When neglected, patients develop uremic coma and then death follows.

Diagnostics

Diagnosis is based on symptoms, complaints of the patient, the results of clinical and laboratory studies.

Appointed:

general and biochemical analysis of urine;
blood tests;
Ultrasound of the urinary system;
radiography;
MRI and/or CT of the abdomen.

Mandatory differential diagnosis with other diseases, primarily with ketoacidotic and hepatic coma.

Treatment of uremic coma

It should begin with emergency measures, which, depending on the severity of the patient, include:

mechanical ventilation of the lungs. indirect heart massage;
oxygenation;
detoxification therapy;
continuous monitoring of pulse, pressure, respiration.

Be sure to wash the stomach and intestines. For these purposes, a solution of sodium bicarbonate is used. Saline laxatives are also important.

In the presence of hyponatremia, an isotonic sodium chloride solution is injected, with hypernatremia and high blood pressure, antihypertensive drugs (for example, Vasocardin), Spironolactone are administered.

It is also necessary to take measures to eliminate acidosis, hypokalemia or hyperkalemia, dehydration, and correct protein metabolism. If the disease is aggravated by infectious processes, special antibiotics and antibacterial agents are prescribed.

In almost all cases, extracorporeal hemodialysis is necessary. If the kidney parenchyma undergoes irreversible changes, surgical treatment for transplantation is performed.

Prevention

The main preventive direction is the timely elimination and treatment of chronic diseases, infectious processes, all changes that can subsequently lead to the formation of uremic coma. To do this, patients should regularly undergo a clinical examination by a specialist, take laboratory tests, perform ultrasounds and monitor their diet.

Folk remedies

They are used both as an addition to drug treatment, and to prevent the development of complications from the kidneys.

To relieve swelling, reduce inflammation, eliminate infection, remove sand and stones from the kidneys, medicinal herbs are used: bearberry, elecampane, juniper, birch buds, knotweed, meadowsweet, cocklebur and lingonberry leaves.

Any use of folk remedies and methods should be discussed with the attending physician.

Galina Vladimirovna

) or urination develops due to endogenous (internal) intoxication of the body caused by severe acute or chronic insufficiency of kidney function.

Causes of uremic coma

In most cases, uremic coma is the result of chronic forms of glomerulonephritis or pyelonephritis. In the body, toxic metabolic products are formed in excess, which sharply reduces the amount of daily urine excreted and coma develops.

Extrarenal reasons for the development of uremic coma include: drug poisoning (sulfanilamide series, salicylates, antibiotics), industrial poisoning (methyl alcohol, dichloroethane, ethylene glycol), shock conditions, indomitable and incompatible blood transfusion.

In pathological conditions of the body, a violation 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). Gradually increases the concentration of urea, creatinine and uric acid, which leads to 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 to anorexia (refusal to eat). The patient has dryness and a taste of bitterness in the mouth, smells of ammonia from the mouth, increased thirst. Often associated with stomatitis, enterocolitis.

Patients with growing uremic coma have a characteristic appearance - the face looks puffy, the skin is pale, dry to the touch, traces of scratching are visible due to unbearable itching. Sometimes powder-like deposits of uric acid crystals can be observed on the skin. Hematomas and hemorrhages, pastosity (pallor and decreased elasticity of the skin of the face against a background of slight edema), edema in the lumbar region and the region of the lower extremities are visible.

Hemorrhagic syndrome is manifested by uterine, nasal, gastrointestinal bleeding. On the part of the respiratory system, his disorder is observed, the patient is worried about paroxysmal shortness of breath. Blood pressure drops, especially diastolic.

The increase in 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 a coma. In this case, there may be periods of sudden psychomotor agitation, accompanied by delusions and hallucinations. With an increase in a coma, involuntary twitches of individual muscle groups are acceptable, the pupils narrow, and tendon reflexes increase.

The pathogenesis of uremic coma

The first important pathogenetic and diagnostic sign of the onset of uremic coma is 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 as disorders of the 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, there is a violation of the ability of the kidneys to concentrate urine, which is manifested by polyuria. In the terminal stage of renal failure, oliguria develops, 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, a decrease in blood pressure, skin turgor, increased heart rate, thickening of the blood.

In the early polyuric stages of the development of uremia, hypokalemia is observed, which is expressed by a decrease in muscle tone, shortness of breath, often.

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

The third most important link in the development of uremia is a violation of the acid state of the blood and tissue fluid. At the same time, metabolic acidosis develops, accompanied by shortness of breath and hyperventilation.

Expert editor: Mochalov Pavel Alexandrovich| MD general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

30.06.2018 Doctor Evgenia Alexandrovna Miroshnikova 0

Danger of uremic coma

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

There may be hemorrhages in the brain, epidermis and mucous tissues of internal organs. Then the person falls into a state of stupor. Everything ends in a coma.

Long-term kidney disease, which is chronic, is often accompanied by serious complications. Azotemic coma is one of the most severe pathological conditions requiring emergency medical care. As a rule, it occurs as a result of permanently occurring glomerulonephritis, pyelonephritis, amyloidosis, polycystic kidney disease and other diseases.

Coma is diagnosed, as a rule, on the basis of characteristic signs of prolonged kidney damage and the dynamics of the disease. Both are recorded in the patient's medical record. The coma of the patient suggests emergency measures to avoid death. First of all, it is necessary to bring a person out of a coma. Emergency measures include resuscitation of vital organs (heart and lungs), control of breathing, blood pressure, pulse.

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

concentrations in the blood of a large number of protein breakdown products, namely: nitrogenous slags, urea, creatinine, uric acid;
deterioration in 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, there is a disruption in the normal functioning of vital internal organs and systems, therefore, azotemic coma is accompanied by severe liver damage and metabolic dysfunction.

The process of developing kidney failure is usually divided into two stages:

initial or hidden - it can be detected only 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 of the pathological condition. With the help of a clearance test, a disorder in the filtration and reabsorption of the kidneys is established. Even a slight excess of the standard indicator signals a violation of the nitrogen excretion capacity of the organ.

It should be noted that the increase in this indicator in conditions of prolonged course of 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 preserved nitrogen in the blood, namely, the content of the substance does not exceed 60 mg; nitrogen-containing carboxylic acid (creatine) - the norm is not 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 electrolyte imbalance.
Terminal - an obvious clinical picture of uremia.

Signs of chronic renal failure are manifested in:

violations of the normal activity of all vital organs (dyspeptic disorders). Characteristic indicators: loss of appetite, thirst, a feeling of dry mouth, bouts of nausea and vomiting, the smell of ammonia from the oral cavity. There is stomatitis, gingivitis and others;
formation of pathological processes (neurological disorders). This is a state of anxiety or stupor, seizures, extreme agitation, muscle cramps, damage to the motor neurons of the motor nuclei of the cranial nerves and anterior horns of the spinal cord, respiratory function is disturbed;
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 functioning of an organ (or its tissue) of neurogenic origin. There is a slowdown in the reactions of the patient, as well as a soporous state, when the patient has a deep sleep, from which it is quite difficult to get him out.

In the process of developing uremia in a patient, the risk of developing pneumonia and bronchitis increases, and a sudden decrease in vision and hearing is also noted. Excruciating itching of the skin, bleeding, deposition of nitrogenous slags (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 seen 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 formed per day (diuresis). Despite the fact that a large amount of fluid is excreted 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 acid-base balance of the body towards an increase in acidity (a decrease in 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 efficiency and ability to concentrate;
headache;
loss of vision and hearing;
memory loss;
drowsiness;
apathy;
smell of ammonia, etc.

In mature people, uremic coma is caused by:

in men, most often prostate adenoma;
in women, it may be the result of pyelonephritis, hormonal metabolism disorders, or other pathologies of the urinary system.

Children endure this condition more severely than adults. They often have:

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

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

Grounds for the formation of a coma

Azotemic uremia is caused by:

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

A prolonged pathological process that develops in the kidneys leads to an increase in oliguria and a decrease in the outflow of urine. Thus, there is: accumulation of urea, uric acids and creatinine, imbalance of acids and alkali in the body, development of metabolic acidosis.

Complications and consequences

With the onset of uremic coma, doctors do not give the most favorable prognosis for the patient. It is best to prevent this condition, to identify the disease at an early stage. Then the methods of treatment will be more effective. Complications worsen the situation, for example, pneumonia. Of particular danger are internal bleeding in the brain, gastrointestinal tract.

The nervous system is subject to serious changes during the period of uremia. After suffering a uremic coma, a change in character is observed in a person, memory suffers, 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 and X-ray of the pelvic floor are the methods used to determine the source of the disease. These diagnostic methods make it possible to detect the presence of stones in the genitourinary system and determine changes in the structure of kidney tissues. In some cases, computed tomography is performed. Additionally, an 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 of the body.

Treatment and emergency care

A patient in a state of uremic coma is admitted to the intensive care unit. Doctors carry out medical and hardware therapy. Medications, diuretics, saline, and glucose are given intravenously. In especially severe cases, hormonal drugs are used. With the help of special devices, blood purification procedures (hemodialysis and plasmapheresis) are carried out.
Hemodialysis

First Aid Receptions:

neutralization of intoxication;
restoration of water and electrolyte balance;
normalization of blood pressure;
with the help of symptomatic therapy, certain especially dangerous signs of coma, for example, convulsions, are eliminated;
hemodialysis.

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

surgery to remove stones from the kidneys and bladder;
changing the diet and avoiding 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;
cure all inflammatory processes occurring inside the body, especially in the organs of the genitourinary system;
carefully undergo a course of therapy for the pathology that led to the formation of renal failure (prolonged glomerulonephritis, pyelonephritis, polycystic disease, diabetes, and others).

If there is already kidney failure, then the patient needs to register with a medical institution as soon as possible, methodically and systematically treat the disease, following all the recommendations of a specialist. In addition, complications, surgical operations, bleeding should be avoided. Normalization of blood circulation in case of its insufficiency will significantly reduce the risk of renal coma.

In conclusion, it should be said 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 control. The same rule applies to the use of antimicrobial agents (sulfonamides), drugs that have a depressant effect on the central nervous system (barbiturates), analgesics and other medications.

Alternative treatment

Alternative medicine, which includes homeopathy and traditional medicine, is quite capable of slowing down the formation of uremia and limiting the rehabilitation period.

Folk recipes:

the use 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 not small pieces);
useful kefir and whey;
convulsions are relieved by wrapping the patient in a damp cloth, wetting it in cold water. Then the person needs to be wrapped in a blanket.
enter the days when the patient eats only fruit. This is an effective prophylactic of the disease;
decoctions of juniper, wild rose, elderberry, horsetail, St. John's wort.

Homeopathy

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

ammonia is used to stimulate the work of the heart, especially if there is blood, protein, hyaline cylinders in the urine;
hydrocyanic acid - effective in case of agony during coma;
common barberry has analgesic and anti-inflammatory properties, and is also used for a more intensive process of removing fluid from the body. Barberry helps to remove excess salts, eliminate deposits and prevent their re-formation;
hellebore white and bitter gourd activate the blood circulation of the organs located in the peritoneum;
drug Galium-Heel - its action is aimed at reducing the activity of toxins, stabilizing the structure of organs and restoring their functions, and stimulates the immune system. The tool 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 of resuscitation allow you to bring a person out of this state. However, a fatal outcome is not excluded, but this does not occur often. Subsequently, how long a person will live depends on the fulfillment of all the doctor's instructions aimed at preventing factors that provoke uremia.

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

It develops in the terminal stage of chronic kidney disease or acute renal failure of various etiologies.

Symptoms

General weakness precedes. Lack of appetite, nausea, vomiting, diarrhea, thirst, skin itching, lethargy, drowsiness. The skin is pale, dry, with fine peeling and traces of scratching. Urinous odor from the mouth. Sometimes agitation, delirium, hallucinations; pupils are constricted. Breathing speeded up, may be of the Kussmaul type. Blood pressure is usually elevated. In the final stage, a pericardial friction rub is heard. Anemia, leukocytosis, a sharp increase in the level of creatinine, residual nitrogen in the blood, hyperkalemia, metabolic acidosis. Low relative gravity of urine, proteinuria, changes in urine sediment.

First aid

In case of inappropriate behavior and unconsciousness, protect the patient from bodily harm. When vomiting - prevention of aspiration of vomit.

First aid

With high blood pressure intramuscularly 2 ml of 1% dibazol solution; when excited - 1 ml of a 1% solution of diphenhydramine. Gastric lavage and siphon enemas with 2-3% sodium bicarbonate solution, oral administration of activated charcoal, sodium bicarbonate 3 g per 0.5 glass of water 3 times a day.

Medical emergency

Medical Center

Intravenously 400 ml of 5% glucose solution (with a sharp increase in blood pressure in combination with 2 ml of 1% dibazol solution), intramuscularly 2 ml of cordiamine, oxygen inhalation. With persistent vomiting, subcutaneously 0.5 ml of a 0.1% solution of atropine, with a sharp excitation - 1 ml of a 1% solution of diphenhydramine intramuscularly. Evacuation to the hospital on an ambulance, lying on a stretcher, accompanied by a doctor.

Omedb, hospital

With preserved diuresis, additionally intravenously inject 40 mg of furosemide (lasix) in 400 ml of 5% glucose solution or 400 ml of 0.9% sodium chloride solution; 5-10 ml of a 2.4% solution of aminophylline intravenously; with acidosis - 150-200 ml of 4% sodium bicarbonate solution intravenously; with hyperkalemia intravenously drip 400 ml of 20% glucose solution with 16-20 IU of insulin, 20 ml of 10% calcium gluconate solution. With high blood pressure - intramuscularly 1 ml of a 2.5% solution of benzohexonium or 1 ml of a 5% solution of pentamine; intramuscularly or intravenously 1 ml of 0.01% clonidine solution. With infectious complications, antibiotics that do not have a nephrotoxic effect (penicillin, semi-synthetic penicillins, carbenicillin, erythromycin). In the absence of the effect of ongoing conservative therapy and the absence of contraindications - hemodialysis, hemosorption, peritoneal dialysis.