Alteración del estado de conciencia en el paciente intoxicado
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La disminución del estado de conciencia, específicamente el coma, es un motivo de consulta frecuente en el servicio de urgencias y constituye un reto para el personal de salud por el número de condiciones amenazantes de la vida que se acompañan de este signo clínico. La toxicidad en el sistema nervioso central es una de las manifestaciones más comunes en el paciente intoxicado por cuanto se han encontrado signos y síntomas hasta en un 30%. Este porcentaje es considerable en personas en edad laboral pues la morbilidad derivada de un retraso en la atención y las lesiones secundarias, implican repercusiones sociales. Según su acción en el sistema nervioso central los xenobióticos se dividen en dos grupos: estimulantes que causan agitación, delirium o convulsiones y depresores que provocan grados variables de alteración en el estado de conciencia, desde la somnolencia hasta el coma. El propósito de este artículo es revisar las sustancias depresoras, con enfoque en el coma de origen tóxico. Además de la fisiopatología y los principales tóxicos implicados, se plantea, con base en la evidencia, la mejor aproximación a esta clase de pacientes con el objeto de favorecer el uso razonable de los recursos disponibles y evitar complicaciones y disminuir costos al sistema de salud.
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