الفهرس 
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Abstract
Summary : Comas are a major cause of clinical deterioration or death. Identification of risks that predispose to coma are important in managing patients. Coma of unknown etiology (CUE) is a major challenge in emergency medicine. CUE is caused by a wide variety of pathologies that require immediate and targeted treatment. Therefore the aim of this study was to evaluate comatosed patients, associated factors, causes and outcomes. The study included 420 comatosed patients (232 Male&188 female) that were recruited from different ICU in Specialized Medical Hospital, Mansoura University from January 2019 and Jully 2019, Ethical approval was obtained from the relatives of patients. All patients underwent thorough, full medical history taking, full medical examination, clinical presentation, laboratory investigations and follow up during their hospital stay regarding daily needed laboratory investigations, monitoring the protocol of therapy, and recording fate of it. The current study showed that metabolic cause was the most common cause of coma, especially Hepatic encephalopathy, then hyperglycemic emergencies included (DKA&HHS), then hypoglycemia, and uremic encephalopathy. Most of our patients were males with also high mortality rate than females. A highly significant correlation between age and mortality rate as most of died patients were of old age. Hepatic coma in our patient was most commonly with Cirrhosis and chronic hepatitis c virus than with HCC. Hepatic encephalopathy was a significant high mortality rate than other types of coma. Hyperglycemic emergencies included (DKA&HHS), the current study showed that DKA was most common than HHS. The most common cause of DKA in our study was infection. A significant higher mortality rate in HHS than DKA. A highly significant higher levels of blood glucose and HbA1C in HHS than DKA. A significant low GCS was in HE than DKA & HHS. Also significant decreased in platelet count with CLD than with others. Hypoglycemia is a common contributor to morbidity and mortality in T1D. In ourstudy, patients with hypoglcemia was commonly with old aged. The most common cause of hypoglycemia was Increased dose of insulin. Hypertension was the most common associated disease among our patients. A significantly increased risk of AKI in critically ill patients with older age, diabetes, higher baseline creatinine, heart failure, sepsis and possibly hypertension in different ICUs. Uremic encephalopathy (UE) was in patients with acute kidney injury or severe chronic kidney disease, CKD associated with a significant high mortality rate. The current study included other causes of coma but less common in our ICU such as: stroke, cardiac arrest, septis, hypothyroidism, HTN encephalopathy, Lupus nephritis.