{ "schema_version": 1, "kind": "condition", "id": "coma", "name": "Coma", "category": "chronic", "sources": "Coma - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK430722/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AS53 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · MSF Essential Drugs 2024, GLUCOSE 50% = DEXTROSE 50% injectable · MSF Essential Drugs 2024, NALOXONE injectable", "review_status": "reviewed", "verified_against": "No dose - referral pathway, no medicine given in primary care", "verified_date": "2026-08", "treatments": [ { "id": 449, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "A medical emergency requiring immediate transfer; a GP's only role is a rapid ABC check plus a holding measure (glucose if hypoglycaemic, naloxone if opioid overdose suspected) before urgent transfer.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "A medical emergency requiring immediate transfer; a GP's only role is a rapid ABC check plus a holding measure (glucose if hypoglycaemic, naloxone if opioid overdose suspected) before urgent transfer.", "cautions": [ "RED FLAG - Airway compromise or respiratory arrest: assess urgently and refer.", "Referral is the pathway; the medicines listed alongside are what primary care can give before or while it happens.", "RED FLAG - Any coma is itself an emergency. Unequal or fixed pupils, signs of head trauma, seizure activity, hypoglycaemia on fingerstick glucose, or signs of opioid toxicity (pinpoint pupils, slow breathing) each need immediate emergency management." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "coma" }, { "id": 450, "generic": "Glucose (dextrose)", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "50% glucose (500 mg/mL) 1 mL/kg by slow intravenous injection over 3 to 5 minutes", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024, GLUCOSE 50% = DEXTROSE 50% injectable - verbatim: \"Adult: 1 ml/kg by slow IV injection\"", "rationale": "Hypoglycaemia is one of the few causes of coma a primary-care doctor can reverse on the spot, and a bedside glucose reading takes seconds.", "cautions": [ "Give into a large vein through a large-bore needle and never intramuscularly or subcutaneously - the solution is viscous and causes tissue necrosis if it leaks out of the vein.", "Recheck the blood glucose after the injection; if it is still low, repeat the dose or give oral glucose depending on how awake the patient is.", "This treats hypoglycaemia, not coma in general. Give it for a low or unobtainable bedside glucose, not as part of a routine cocktail, and still arrange urgent transfer." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Do not use the 50% solution in children - it is too concentrated and irritant. Use 10% glucose at 2 mL/kg by slow intravenous injection; if no ready-made 10% is at hand, 10 mL of 50% glucose added to 100 mL of 5% glucose makes it.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DEXTROSE 50% (OTSUKA) I.V. INF. 25 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OTSUKA", "price_egp": 3.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXTROSE 50% (MISR) I.V. INJ. 20 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXTROSE 50% (OTSUKA) I.V. INF. 500 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OTSUKA", "price_egp": 14.2, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXTROSE 25% (ALLMED) I.V. INF. 500 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALLMED MIDDLE EAST", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXTROSE 5% (EL NILE) I.V. INF. 500 ML (RUBBER CAP)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 11.25, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLUCOSE 5% (OTSUKA) I.V. INF. 1000 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OTSUKA", "price_egp": 14.75, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXTROSE 5% (MUP) I.V. INF. 500 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 33.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLUCOSE 5% (INTRA PHARM) I.V. INF. 500 ML (EURO CAP + RUBBER STOPPER)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTRA PHARM", "price_egp": 33.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "coma" }, { "id": 451, "generic": "Naloxone", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "1 to 3 micrograms/kg intravenously, repeated every 2 to 3 minutes until the patient breathes adequately; if no vein, 5 to 10 micrograms/kg intramuscularly, repeatable every 90 minutes", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024, NALOXONE injectable - verbatim: \"Adult: 1 to 3 micrograms/kg by IV injection, repeated if necessary after 2 to 3 minutes\"", "rationale": "Pinpoint pupils with a slow respiratory rate in an unresponsive patient point to opioids, and naloxone is the one antidote a clinic can give while waiting for the ambulance.", "cautions": [ "Naloxone wears off in 20 to 30 minutes while the opioid does not, so the patient can stop breathing again - keep giving it and keep the patient under observation for hours, never send them home after one ampoule.", "It supports, and does not replace, assisted ventilation and oxygen.", "In someone dependent on opioids it can precipitate an abrupt withdrawal syndrome; give the smallest dose that restores breathing.", "It reverses opioids only and will do nothing for benzodiazepine, alcohol or other sedative poisoning." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children need a higher weight-based dose than adults: 5 to 10 micrograms/kg intravenously, repeated every 2 to 3 minutes until breathing is adequate.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "XEROPIUM 0.4MG/ML 10 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 100.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RESCUERIX 0.4MG/ML IM/IV/SC 10 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO > HOPE PHARMA", "price_egp": 120.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "coma" } ] }