Ayurvedic Management of Hypercapnic Encephalopathy...

Ayurvedic Management of Hypercapnic Encephalopathy (carbon dioxide [CO2] narcosis). Definition • Hypercapnia is defined as a PaCO2 in excess of 45 mmHg (6 kPa) at rest. CO2 narcosis may occur when PaCO2 exceeds 90 mmHg (12 kPa). Causes Central(reduced respiratory drive) Cerebral lesions (encephalitis, stroke, brainstem lesions), obstructive sleep apnoeas, respiratory depressant overdose (sedatives, narcotics, antidepressants), metabolic alkalosis, hypothermia Neuromuscular Peripheralneuropathy, myasthenia gravis, myopathies, amyotrophic lateral sclerosis, cervical spine injury, transverse myelitis, Guillain-Barré syndrome, tick paralysis, periodic paralysis, toxins (organophosphates, tetanus, botulism, strychnine), metabolic (hypokalaemia, hypomagnesaemia) Chest wall Kyphoscoliosis, ankylosing spondylitis, chest trauma, pectus excavatum Pulmonary Chronic bronchitis, emphysema, end-stage interstitial lung disease Others Angio-oedema, epiglottitis, foreign body aspiration, malfunctioning mechanical ventilator Mechanisms • Decreased ventilatory drive (“won't breathe"). • Malfunction of the respiratory pump or increased airway resistance (“can't breathe"). • Inefficiency of gas exchange (increased dead space or V/Q mismatch). • Increased CO2 production. Clinical features • Intense headache that is generalised or bilateral frontal or occipital. It is especially severe on waking up. • Intermittent drowsiness, indifference or inattention, reduction of psychomotor activity and forgetfulness in mild cases. • Mental dullness, drowsiness, confusion, stupor, seizures and coma in severe cases. • Manifestations of underlying disorder. Signs • Fast- frequency action tremors • Bounding peripheral pulses. • Muscle twitching (fasciculation) • Papilloedema • Flushed tremor warm extremities Flapping tremors Investigations • ABG studies confirm hypercapnia. • Relevant investigations in relation to the underlying aetiology. Treatment • If oxygen saturation is <90%, administer oxygen. Use low-flow rate of 1-2 L/minute initially in patients with chronic obstructive lung disease. • Mechanical ventilation with intermittent positive-pressure respirator. In a selected group of patients with mild symptoms, non- invasive ventilation (NIV) may be tried. • Correction of acidosis (if severe) and electrolyte imbalance. • Treatment of underlying disorder. Ayurvedic treatment We use total herbal ayurvedic medicine in such cases and got successful result According to patients we do shodhan panchakarma treatment vaman, virechan, basti , nasya etc., After shodhana use shaman chikista for improve health of brain and lungs. Use herbal medicine like adulasa , yasti, tankan, ela, lavang , turmeric etc We make our own herbal combination for better results, kas rasayan, pratishyay rasayan, shwas yog, lakshmi narayan ras, shwaskuthar ras, etc We aaply some lepas on chest for increase o2 level of lungs. After treatment we give rasayan treatment for avoid recurrences in such cases.we use chyavan prash, agasthi rasayan etc for best result.