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Hypercapnic coma due to spontaneous pneumothorax: case report and review of the literature.
MedLine Citation:
PMID:  19272744     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background: Hypercapnic coma is a rare differential diagnosis in the unconscious patient. One underlying mechanism may be hypoventilation due to spontaneous pneumothorax. Although hypercapnia is not a typical finding in spontaneous pneumothorax in patients with otherwise healthy lungs, under certain circumstances, hypercapnia may readily develop. Objectives: We report a rare case of profound hypercapnic coma due to spontaneous pneumothorax after contralateral pneumonectomy. In addition, we review other causes of hypercapnic coma and its outcome and discuss the relationship between arterial carbon dioxide partial pressure and level of consciousness. Case Report: An 85-year-old man without evidence of trauma or intoxication presented unconscious to our Emergency Department. The physical examination and X-ray study revealed a left-sided spontaneous pneumothorax. A right-sided pneumonectomy 25 years earlier had promoted the development of profound hypercapnic coma. After insertion of a thoracic drain, the coma rapidly resolved without any neurological deficit. Conclusions: Although severe hypercapnia is usually due to decompensation of chronic lung disease, pneumothorax potentially may cause hypercapnic coma. Review of the literature suggests that there is no close correlation between arterial pCO(2) (partial pressure of CO(2)) levels and the degree of impairment of consciousness; however, levels exceeding 80 mm Hg are likely associated with significantly impaired consciousness. Hypercapnic coma usually resolves without neurological deficit as arterial pCO(2) tensions decline.
Authors:
Martine Otten; Lothar A Schwarte; J Wolter A Oosterhuis; Stephan A Loer; Patrick Schober
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Publication Detail:
Type:  Journal Article     Date:  2009-03-09
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  42     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
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