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Symptoms and Signs – Differential Diagnosis of Coma in Pediatric Cases ANOXIA • Birth asphyxia • Carbon monoxide (CO) poisoning • Croup/epiglottitis • Meconium aspiration INFECTION • Hemolysis • Blood loss • Hydrops fetalis • Meningoencephalitis • Sepsis • Postimmunization encephalitis INCREASED INTRACRANIAL PRESSURE • Anoxia • Inborn metabolic errors • Toxic encephalopathy • Reye’s syndrome • Head trauma/intracranial bleed • Hydrocephalus • Posterior fossa tumors HYPERTENSIVE ENCEPHALOPATHY • Coarctation of aorta • Nephritis • Vasculitis • Pheochromocytoma ISCHEMIA • Hypoplastic left side of heart • Shunting lesions • Aortic stenosis • Cardiovascular collapse (any cause) PURPURIC CAUSES • Disseminated intravascular coagulation • Hemolytic-uremic syndrome • Leukemia • Thrombotic purpura HYPERCAPNIA • Cystic fibrosis • Bronchopulmonary dysplasia • Congenital lung anomalies NEOPLASM • Medulloblastoma • Glioma of brainstem • Posterior fossa tumors DRUGS/TOXINS • Maternal sedation • Alcohol • Any drug • Lead • Salicylism • Arsenic • Pesticides ELECTROLYTE ABNORMALITIES • Hypernatremia (diarrhea, dehydration, salt poisoning) • Hyponatremia (syndrome of inappropriate antidiuretic hormone [SIADH], androgenital syndrome, gastroenteritis) • Hyperkalemia (renal failure, salicylism, androgenitalism) • Hypokalemia (diarrhea, hyperaldosteronism, salicylism, diabetic ketoacidosis [DKA]) • Hypocalcemia (vitamin D deficiency, hyperparathyroidism) • Severe acidosis (sepsis, cold injury, salicylism, DKA) HYPOGLYCEMIA • Birth injury or stress • Diabetes • Alcohol • Salicylism • Hyperinsulinemia • Iatrogenic POSTSEIZURE • Renal causes: nephritis, hypoplastic kidneys • Hepatic causes: acute hepatitis, fulminant hepatic failure, inborn metabolic errors, bile duct atresia 
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