Hypercapnic Coma Due to Spontaneous Pneumothorax: Case Report and Review of the Literature

Abstract 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, unde...

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Bibliographic Details
Published in:The Journal of emergency medicine 2012, Vol.42 (1), p.e1-e6
Main Authors: Otten, Martine, MD, Schwarte, Lothar A., MD, PHD, Oosterhuis, J. Wolter A., MD, PHD, Loer, Stephan A., MD, PHD, MSC, Schober, Patrick, MD
Format: Article
Language:English
Subjects:
Aged, 80 and over
carbon dioxide
Carbon Dioxide - physiology
coma
Coma - etiology
Coma - physiopathology
consciousness
Consciousness - physiology
Emergency
Humans
hypercapnia
Hypercapnia - etiology
Male
Partial Pressure
Pneumonectomy - adverse effects
pneumothorax
Pneumothorax - complications
unconscious
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Summary:Abstract 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 pCO2 (partial pressure of CO2 ) 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 pCO2 tensions decline.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2008.10.020