==UNCONSCIOUSNESS==

There are a large number of toxins that can lead to coma of which the most common (in Australia) are

* [[Benzodiazepines]]
* [[2.1.11.9.2.1 Tricyclic Antidepressants|Tricyclic antidepressants (TCAs)]]
* [[2.1.11.9.3 Antipsychotics|Neuroleptics]]
* [[2.1.11.2 Anticonvulsants|Anticonvulsants]]
* [[2.1.11.5.1 Acute Management of Alcohol Problems|Alcohol]]
* [[2.1.1.3 Opioids|Opioids]]

In addition there are a number of less common toxins, which are important to diagnose as they have severe effects and specific treatment.

* [[2.1.11.9.4 Mood stabilizers|Lithium]]
* [[Barbiturates]]
* [[Miscellaneous anxiolytics, sedatives, hypnotics|Chloral hydrate]]
* [[2.1.7.1.2 Sulphonylureas|Hypoglycaemic drugs]] and [[2.1.7.1.1 Insulin|insulin]]
* [[2.2.7.4.5 Organophosphates|Organophosphates]]
* Toxic alcohol ([[2.2.5.2.5 Methanol|methanol]], [[2.2.5.2.2 Ethylene glycol|ethylene glycol]] & isopropanol)
* [[2.2.9.1.1 Carbon monoxide|Carbon monoxide (CO)]]

Clearly, there are also large numbers of other drugs that may lead to impairment of consciousness by reducing cerebral blood flow or causing seizures. These will not be discussed here.

Features that help to differentiate between these drugs are

* [[Response to Painful Stimuli]]
* [[Pupil Size and Reaction]]
* [[Myoclonic Jerking or Hyperreflexia]]
* [[NYSTAGMUS|Nystagmus]]
* [[Odour]]
* [[Heart rates|Heart Rate]]
* [[Bowel Sounds]]
* [[ECG Changes]]
* Response to Antagonists
* [[Electrolytes & Blood Glucose|Electrolytes and Blood Glucose]]
* [[Drug monitoring|Blood Concentrations]]