TY - JOUR T1 - Lesson of the month 2: A case of coma in a Parkinson's patient: a combination of fatigue, dehydration and high protein diet over the New Year period? JF - Clinical Medicine JO - Clin Med SP - 449 LP - 451 DO - 10.7861/clinmedicine.14-4-449 VL - 14 IS - 4 AU - Nirmalan Arulanantham AU - Ralph Wing Fung Lee AU - Tom Hayton Y1 - 2014/08/01 UR - http://www.rcpjournals.org/content/14/4/449.abstract N2 - Although motor fluctuation can often be severe in Parkinson's disease (PD), it is rare for an ‘off period’ to result in coma. The case presented here is of a patient with longstanding PD who was admitted to our hospital with a Glasgow Coma Scale of three after missing just one or two doses of her medication. Investigation for infective, neurovascular and metabolic causes of coma were negative and the patient recovered very rapidly following reinstitution of dopaminergic therapy via nasogastric tube. This case highlights how florid the presentation of motor fluctuations in PD can be and the importance of restarting treatment as quickly as possible. Guidance is provided on how to administer dopaminergic medications in patients who are unable to swallow. ER -