Book of Medical Disorders in Pregnancy - Tintash

has been carried out. There can be
history of over dosage with insulin in
these cases. Blood and urine sugar and
ketone bodies will help in differentiating
this condition from eclampsia.
In diabetic, coma the patient is
dehydrated and collapsed. Acetone will
be smelt in the breath and urine will
contain sugar and ketones.
Hypoglycemic coma is marked by
collapse, low blood pressure, sweat-ing
and low blood sugar. It is result of over
dosage of insulin. Careful search of skin
for signs of hypodermic injection is
essential.
Uremic coma - This is marked by dehydration,
dyspnea, high blood pressure,
hypertensive retinopathy and presence of
albumin in urine. The specific gravity of
urine is usually in the region of 1010.
The blood urea will be much elevated.
Hepatic coma - This usually follows a
period of prolonged illness. In pre-coma
stage, there may be psychosis which is
accompanied by flapping tremor. Other
features of liver disease such as foetor
hepaticus, jaundice or ascites may be
present.
Hypocalcemic convulsion (tetany) - In
this condition, there is paroxysmal tonic
spasm of the hands and feet. Hands
assume conical attitude with fingers
extended at the inter phalangeal joints.
They are adducted and slightly flexed at
the metacarpophalangeal joints. The thumb
is adducted and the palm hallowed.
The toes are flexed towards the sole.
There is planter flexion and the foot is
inverted. When such a convulsion can be
produced by arresting the circulation in a
limb for 3 to 4 minutes (Trousseau's
61
sign) or by percussion of the superior
motor or facial nerve which will produce
spasm (Chvostek’s sign) the diagnosis of
hypocalcemic convulsion can be confirmed.
Poisoning:
Any type of poisoning may result in
coma and convulsions. This may be
common finding in countries where
quacks and traditional birth atten-dants
use herbal medicines and powders to
relieve labour pain. Carbon Monoxide is
present in the coal gas and in the fumes
given off by any fire or explosion. It
unites with blood to form carboxyhemoglobin,
which is cherry red and
imparts this hue to complexion of the
patient. Spectroscopic examination of
blood will con-firm diagnosis. Strychnine
is an alkaloid which is obtained
from nux vomica seeds. This has powerful
stimulant effect on the spinal cord.
When convulsions are of sudden onset
with previous history of good health,
poisoning should be suspected. In strychnine
poisoning the contractions are
violent and are first clonic, later tonic.
The whole body is arched backward or
bends forward or to the side. It does not
commence in the lower Jaw muscles as
it does in tetanus. Similarly during the
interval, the muscles are relaxed.
Alcoholism: The coma is not so deep,
there is marked pallor, sweating, and
stertorous breathing present. The pupils
are dilated; smell of alcohol may be
present. Examination of blood will show
alcohol content in excess of 300 mg
percent.
Heat stroke - Hyperpyrexia and absence
of sweating are diagnostic features of
coma due to heat stroke. Pregnant