Unilateral fixed dilated pupil in a ventilated child with asthma

• Published in: European journal of emergency medicine Vol. 7; no. 3; p. 247
• Main Authors: Geraerts, S D, Plötz, F B, van Goor, C, Duval, E L, van Vught, H
• Format: Journal Article
• Language: English
• Published: England 01-09-2000
• Subjects: Asthma - therapy; Bronchodilator Agents - adverse effects; Child; Humans; Ipratropium - adverse effects; Male; Pupil Disorders - chemically induced; Respiration, Artificial
• ISSN: 0969-9546
• DOI: 10.1097/00063110-200009000-00015

An 11-year-old boy known to have asthma was referred to our intensive care unit (ICU) with progressive respiratory distress. He was sedated, paralysed, and intubated approximately 3 hours after arrival and nebulization with salbutamol and ipratropium was continued on the ventilator. About 16 hours later, he presented with transient unilateral fixed dilated pupils which resolved spontaneously without any neurological deficit. Computerized tomography scan revealed no signs of generalized cerebral oedema. Local contamination with ipratropium was most likely to be the cause of pupil dilatation, which could have occurred during connecting and disconnecting the nebulization system or through contaminated hands.