A 10-year-old child with status asthmaticus, hypercapnia and a unilateral dilated pupil.

This article reports the case of a 10-year-old child with an exacerbation of asthma requiring mechanical ventilation. His immediate course was complicated by significantly elevated arterial CO(2) tensions and a unilateral dilated pupil. A computed tomography scan of his brain failed to demonstrate any evidence of intracranial hypertension or cerebral edema, and he went on to make an uncomplicated recovery, with no evidence of neurological sequelae. The most likely diagnosis appeared to be local contamination with ipratropium when he was receiving frequent nebulizers prior to mechanical ventilation. Similar cases reported in the literature are reviewed, with a discussion of clinical management, implications of permissive hypercapnia and neurological complications in ventilating asthmatic patients and the importance of safe drug handling by staff members.