Ventilation/Perfusion Mismatch in a Child Following Cocaine Ingestion: Case Report

The effects of acute cocaine toxicity on lung physiology and potential ventilation/perfusion (V/Q) mismatch in children is not well described. Herein, we report a case of V/Q mismatch and profound end-tidal CO₂ (EtCO₂) to serum partial pressure CO₂ (PCO₂) discordance occurring in a child who tested positive for cocaine, thought to be from cocaine-induced pulmonary vasospasm (dead space). This has not previously been described in the pediatric population. Clinicians should consider the possibility of cocaine-induced pulmonary vasospasm and V/Q mismatch in children with altered mental status and otherwise unexplained significant EtCO₂ and PCO₂ discordance.