Modes of dying

  • Cerebral hypoxia

    This occurs when the brain does not receive enough oxygen. It may occur secondary to respiratory failure. It may be preceded by being unconscious or by feeling faint. The criterion is
    brain O2 delivery < 60 ml/min

  • Cerebral oedema

    This occurs when osmosis causes cells to expand; commonly secondary to hyponatraemia. It may be preceded by confusion. The criterion is
    ICF volume > 45 litres.

  • Congestive cardiac failure

    Often fluid overload can lead to a very high right atrial pressure; according to the Starling curve's shape, this compromises cardiac output, and leads to heart failure and cardiogenic shock. The criterion is
    brain O2 delivery < 60 ml/min and RAP > 9 mmHg

  • Hypovolaemia

    Dehydration may lead to low blood volume, and this decreases the right atrial pressure. This impairs ventricular filling, decreases cardiac output, and leads to cardiogenic shock. It is preceded by tachycardia, hypotension and fainting. The criterion is
    Brain O2 delivery < 60 ml/min and RAP < 2.5 mmHg

  • Brain haemorrhage

    If the blood pressure is too high, a haemorrhagic stroke is likely; it may be precipitated by fluid overload or sympathetic overactivity. It may be preceeded by headache. The criterion is
    Arterial pressure > 220 mmHg

  • Cerebral hypoglycaemia

    The brain cannot function when deprived of both glucose and ketones. A hypoglycaemic episode usually follows an insulin overdose (relative to glucose intake and requirement). It is preceded by feeling faint and unconsciousness. The criterion is
    blood glucose < 0.2 mmol/L

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