![pinpoint pupils and drugs pinpoint pupils and drugs](https://i.pinimg.com/236x/da/c1/3a/dac13a8594172c3a87469b484957e81b.jpg)
![pinpoint pupils and drugs pinpoint pupils and drugs](https://springhillrecovery.com/wp-content/uploads/high-eyes-1-1024x575.jpg)
![pinpoint pupils and drugs pinpoint pupils and drugs](https://pbs.twimg.com/media/DS2Y8LvW4AAYLzU.jpg)
With external warming and discontinuation of her atracurium, her core temperature returned to 36.6☌ and her pupils decreased in size to 4 mm and became reactive. Emergent computed tomography of the head revealed no evidence of hemorrhage, edema, or mass effect. She was hyperventilated and treated with thiopental and mannitol with no change in pupil size. At that time, she was hypothermic with a core body temperature of 32.8☌. On ICU day 3 she was noted to have dilated (7 mm) nonreactive pupils ( fig. h -1with increasing doses required to maintain neuromuscular blockade.Atracurium was administered for 88 h in doses of 0.5 to 2.6 mg At all times the patient was heavily sedated with a combination of an opioid (hydromorphone, fentanyl) and a benzodiazepine (midazolam) infusion.
#Pinpoint pupils and drugs skin
Her course was complicated by Grade IV graft versus host disease of skin and liver (bilirubin 5.1 mg/dl), renal failure (blood urea nitrogen 106 mg/dl and creatinine 3.9 mg/dl), and septic shock, requiring mechanical ventilation and continuous inotropic support. Postmortem examination revealed no central nervous system abnormalities.Ī 17-yr-old, 50-kg, adolescent girl was admitted to the ICU for respiratory failure secondary to diffuse alveolar hemorrhage and myocardial dysfunction 26 days after allogeneic bone marrow transplant for chronic myelogenous leukemia. The patient died on ICU day 45 secondary to progressive lung disease. Other medications that may have affected pupil size included oral naloxone, and intermittent doses of pentobarbital, lorazepam, meperidine, diphenhydramine, and hydroxyzine, but no changes in the administration of these drugs occurred during the periods of pupillary changes. There was no interruption of his infusions of opioids or pressors at times of pupil dilation and bolus administration of opioids given in response to pupil dilation had no effect on pupil size. Within 2 h, the pupils decreased to 5 mm and were reactive. In view of a recurrent pattern of mydriasis associated with atracurium (ICU days 21, 24, 27, and 40 fig. On day 43 of his intensive care admission, he was noted to have dilated (9 mm) and nonreactive pupils ( fig. Atracurium was administered for 632 h in doses of 0.58 to 2.83 mg The patient was continuously sedated with a combination of an opioid (fentanyl, morphine) and a benzodiazepine (midazolam) infusion. The ICU course was remarkable for prolonged mechanical ventilation (adult respiratory distress syndrome and Aspergillus pneumonia), pressor-dependent septic shock, dialysis-dependent renal failure, and severe cholestatic jaundice (direct bilirubin 25 mg/dl) secondary to graft versus host disease. A 20-yr-old, 60 kg, man was admitted to the ICU 9 days after allogeneic bone marrow transplant for relapsed acute myelogenous leukemia.