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Phencyclidine Intoxication

Phencyclidine/arylcyclohexylamine Delirium


Presentation

  • Most patients presenting to the ED with PCP intoxication do well and can be discharged home after a period of observation.[ncbi.nlm.nih.gov]
  • We chronicle here a unique case of a patient who presented with atypical left chest pain and dizziness for 6 hours. His pain started after he smoked phencyclidine-laced cannabis. Cardiac panel demonstrated normal troponin T levels.[ncbi.nlm.nih.gov]
  • Because phencyclidine intoxication has both psychiatric and physical manifestations, it continues to present a challenge to physicians. Intoxication may be viewed as occurring in three stages.[ncbi.nlm.nih.gov]
  • The first report of electroencephalographic findings in clinically encountered phencyclidine intoxication is presented.[ncbi.nlm.nih.gov]
  • Marked hyperuricemia was present in all 17 patients, and marked hyperphosphatemia and hypocalcemia were noted in the 10 patients with acute renal failure; 3 of the latter developed hypercalcemia during the diuretic phase of the illness.[ncbi.nlm.nih.gov]
Fever
  • Fever, tachycardia and hypertension were frequent findings among the 25 patients with rhabdomyolysis and all had leukocytosis. The data show that rhabdomyolysis with and without acute renal failure is not infrequent among abusers of PCP.[ncbi.nlm.nih.gov]
  • Fever, tachycardia and hypertension were frequent findings among the 25 patients with rhabdomyolysis and all had leukocytosis. The data show that rhabdomyolysis with and without acute renal failure is not infrequent among abusers of PCP. 1981 S.[karger.com]
  • Misuse can cause blurred vision, body itching, rash, sweating, fever, hypertension, shallow respiration, diarrhea, toxic psychosis, coma, and an increase in heart rate, blood pressure, and body temperature.[www1.nyc.gov]
  • Many people find it unpleasantly reminiscent of fever dreams.[erowid.org]
Drooling
  • This may be accompanied by nausea, vomiting, blurred vision, vertical nystagmus, drooling, loss of balance, and dizziness.[usmleforum.com]
  • According to the DOI, here are some of the physical symptoms of PCP intoxication: Drooling Sweating Nystagmus or strange, jerking movements of the eyes Impaired motor skills (ex.[phencyclidine.org]
  • PCP can also cause these physical side effects: body numbness dizziness drooling slurred or garbled speech loss of muscle coordination and balance profuse sweating rapid, involuntary eye movements or a blank stare nausea and vomiting PCP is addictive.[m.kidshealth.org]
  • Vomiting and drooling may occur. In the stuperous phase the eyes are wide open, and the person appears wide awake, but in a stupor. Seizures may occur if the person is stimulated. The eyes may dart in any direction while the gaze remains fixed.[minddisorders.com]
  • This is frequently seen with blurred vision, drooling, ataxia, nausea, vomiting, and dizziness. High doses of PCP, such as those exceeding 200 mg can lead to seizures, coma, and even death (Kumar, Fitz-Gerald, Kablinger, & Arnold, 2010).[theravive.com]
Hypersalivation
  • Profuse diaphoresis, hypersalivation, bronchospasm, and urinary retention occurred in less than 5%. A small percentage had severe disturbances in vital signs, including three cases (0.3%) of cardiac arrest and 28 cases (2.8%) of apnea.[ncbi.nlm.nih.gov]
Hypertension
  • The prevalent clinical signs and symptoms were the following: retrograde amnesia, nystagmus, hypertension, and psychomotor agitation. Co-use of other substances was the norm.[ncbi.nlm.nih.gov]
  • Fever, tachycardia and hypertension were frequent findings among the 25 patients with rhabdomyolysis and all had leukocytosis. The data show that rhabdomyolysis with and without acute renal failure is not infrequent among abusers of PCP.[ncbi.nlm.nih.gov]
  • Similarly, PCP intoxication in man can present with diverse symptoms: schizophrenia-like delusions and hallucinations; mania; violence, dyskinetic, catatonic, or stereotyped movements; hypertension; and coma [11, 12].[ncbi.nlm.nih.gov]
  • Nystagmus and hypertension occurred in only 57% of our cases; some patients had only one of these findings and many had neither. The incidence of violence was 35%; bizarre behavior, 29%; and agitation, 34%.[ncbi.nlm.nih.gov]
  • Antihypertensive agents are not usually needed, but diazoxide and hydralazine hydrochloride have been used to treat hypertensive crises. Diazepam and phenytoin have been used to treat seizures.[ncbi.nlm.nih.gov]
Tachycardia
  • Fever, tachycardia and hypertension were frequent findings among the 25 patients with rhabdomyolysis and all had leukocytosis. The data show that rhabdomyolysis with and without acute renal failure is not infrequent among abusers of PCP.[ncbi.nlm.nih.gov]
  • Within an hour (less when smoked, "snorted," or used intravenously), two (or more) of the following signs: (1) vertical or horizontal nystagmus (2) hypertension or tachycardia (3) numbness or diminished responsiveness to pain (4) ataxia (5) dysarthria[behavenet.com]
  • Tachycardia and mild hypertension are also seen with ketamine but are substantially less severe and unlikely to be life threatening. AUTONOMIC MANIFESTATIONS. Severe hyperthermia has been Observed and can be delayed, fatal, or both.[aibolita.com]
  • Fever, tachycardia and hypertension were frequent findings among the 25 patients with rhabdomyolysis and all had leukocytosis. The data show that rhabdomyolysis with and without acute renal failure is not infrequent among abusers of PCP. 1981 S.[karger.com]
  • Electrocardiography revealed sinus tachycardia. Chest radiography revealed no acute pulmonary findings. Results of a urine toxicology screen were positive for phencyclidine (PCP) and marijuana.[consultant360.com]
Fear
  • NOTHING – other than the fear of "taking a stand" – prevented these authors from offering a CONCLUSION strong enough to help to make a difference and save some lives.[charlydmiller.com]
  • Here are some of the behavioral signs of PCP intoxication: “Poor perception of time and distance” Confusion Agitation Terror Panic Randomness in thought and action Severe anxiety and fear Mood swings Hostile and violent behavior PCP is increased in its[phencyclidine.org]
  • Shelby has said she fired her weapon because she feared for her life. Under Oklahoma law, first-degree manslaughter carries a minimum sentence of four years. She is scheduled to appear in court for a preliminary hearing on Nov. 29.[reuters.com]
  • Such a NDE often results loss of the fear of death and a renewed interest in life. Production of artificial NDE's by ketamine has similarly been found effective to decrease an unatural fear of death.[lycaeum.org]
  • Common effects of PCP include hallucinations, relaxation, drowsiness, difficulty concentrating, anxiety, intense fear and suicidal behavior, as well as distorted sense of time, paranoia, rapid mood swings, and dissociation with the environment.[hallucinogens.com]
Aggressive Behavior
  • Symptoms in 11 patients suspected of phencyclidine intoxication included violent, aggressive behavior with delusions, hallucinations, agitation, and other signs of toxic psychosis.[ncbi.nlm.nih.gov]
  • Benzodiazepines are usually effective in managing aggressive behavior. Anxiety and agitation can be managed by decreasing external stimuli such as noise, light, and touch.[emedicine.medscape.com]
  • Hallucinations, euphoria, and suicidal impulses are also reported, as well as occasional aggressive behavior.[wiki.tripsit.me]
  • Aggressive behaviors may occur with alcohol intoxication, but hallucinations are not seen (Galanter & Kleber, 2014).[theravive.com]
Psychiatric Manifestation
  • The physiologic and psychiatric manifestations of PCP intoxication are diverse and somewhat dose dependent. Urine acidification may hasten drug excretion.[ncbi.nlm.nih.gov]
  • The psychiatric manifestations of Stage I intoxication can resemble a variety of psychiatric syndromes, making differential diagnosis difficult in the absence of toxicology results or a history of recent PCP, ketamine, or DXM intake.[basicmedicalkey.com]
Urinary Retention
  • Profuse diaphoresis, hypersalivation, bronchospasm, and urinary retention occurred in less than 5%. A small percentage had severe disturbances in vital signs, including three cases (0.3%) of cardiac arrest and 28 cases (2.8%) of apnea.[ncbi.nlm.nih.gov]
Agitation
  • The prevalent clinical signs and symptoms were the following: retrograde amnesia, nystagmus, hypertension, and psychomotor agitation. Co-use of other substances was the norm.[ncbi.nlm.nih.gov]
  • Although diazepam [13], haloperidol [14, 15], and chlorpromazine [16] have been reported to improve the agitation and psychotic symptoms caused by PCP, the therapeutic efficacy of these agents has rarely been documented with objective clinical measures[ncbi.nlm.nih.gov]
  • The incidence of violence was 35%; bizarre behavior, 29%; and agitation, 34%. Changes in sensorium consisted of coma, lethargy/stupor, and acute brain syndrome; however, 46% of patients were alert and oriented.[ncbi.nlm.nih.gov]
  • Symptoms in 11 patients suspected of phencyclidine intoxication included violent, aggressive behavior with delusions, hallucinations, agitation, and other signs of toxic psychosis.[ncbi.nlm.nih.gov]
  • If you think you might have taken PCP without your knowledge, or if you know someone who might have taken PCP, it is important to get to a safe place where the individual won’t be further agitated by the environment or by others.[phencyclidine.org]
Seizure
  • Motor signs included grand mal seizures, generalized rigidity, localized dystonias, catalepsy, and athetosis. Profuse diaphoresis, hypersalivation, bronchospasm, and urinary retention occurred in less than 5%.[ncbi.nlm.nih.gov]
  • Diazepam and phenytoin have been used to treat seizures. Ion-trapping by continuous gastric suctioning and by urine acidification with ammonium chloride may increase clearance of PCP.[ncbi.nlm.nih.gov]
  • With higher doses, symptoms can progress to sweating, tremors, confusion, hyperactivity, seizures, stroke, cardiac arrhythmias, and sudden death. At high doses of PCP, there is a drop in blood pressure, pulse rate, and respiration.[usmleforum.com]
  • Among the serious neurologic and medical complications are coma, trauma, infection, seizures, stroke, altered mentation, peripheral neuropathies, myelopathies, Parkinsonism, visual disturbances, dyskinesias, cerebellar ataxia, impotence, and fetal effects[books.google.com]
Confusion
  • Someone high on PCP may show signs of confusion and poor perception. PCP is a “bitter-tasting, white crystalline powder that is easy to dissolve in water or alcohol” ( NDIC ).[phencyclidine.org]
  • With higher doses, symptoms can progress to sweating, tremors, confusion, hyperactivity, seizures, stroke, cardiac arrhythmias, and sudden death. At high doses of PCP, there is a drop in blood pressure, pulse rate, and respiration.[usmleforum.com]
  • Signs of Phencyclidine Intoxication These are some of the common signs and symptoms of phencyclidine (PCP) intoxication: Desire to undress Belligerent behavior Hallucinations Confusion, amnesia Besides the obvious dangers of the above symptoms of being[gomentor.com]
  • Pharmacologic treatment is not necessary in most cases and may confuse the clinical picture.[basicmedicalkey.com]
  • CONSUMERS: Click here for the Consumer Version Ketamine and phencyclidine are dissociative anesthetics that can cause intoxication, sometimes with confusion or a catatonic state. Overdose can cause coma and, rarely, death.[merckmanuals.com]
Nystagmus
  • Clinical findings were the following: retrograde amnesia in 46 (25 %), horizontal nystagmus in 118 (64.1 %), vertical nystagmus in 90 (48.9 %), hypertension in 87 (47.3 %), and agitation in 71 (38.6 %).[ncbi.nlm.nih.gov]
  • When first seen, the patient was in a coma, initially distinguished only by nystagmus, waxy rigidity of the extremities, and an EEG with a widespread, sinusoidal theta rhythm interrupted every few seconds by periodic slow-wave complexes.[ncbi.nlm.nih.gov]
  • In the 27 confirmed cases, the most common abnormalities present on physical examination were mental/behavioral (89%) and nystagmus (85%).[ncbi.nlm.nih.gov]
  • Nystagmus and hypertension occurred in only 57% of our cases; some patients had only one of these findings and many had neither. The incidence of violence was 35%; bizarre behavior, 29%; and agitation, 34%.[ncbi.nlm.nih.gov]
  • Rotary nystagmus may also be seen during ketamine intoxication but is less common. The absence of nystagmus therefore cannot be used to exclude a diagnosis of ketamine intoxication. BEHAVIORAL MANIFESTATIONS.[aibolita.com]
Ataxia
  • Among the serious neurologic and medical complications are coma, trauma, infection, seizures, stroke, altered mentation, peripheral neuropathies, myelopathies, Parkinsonism, visual disturbances, dyskinesias, cerebellar ataxia, impotence, and fetal effects[books.google.com]
  • Within an hour (less when smoked, "snorted," or used intravenously), two (or more) of the following signs: (1) vertical or horizontal nystagmus (2) hypertension or tachycardia (3) numbness or diminished responsiveness to pain (4) ataxia (5) dysarthria[behavenet.com]
  • Although not conclusive or totally specific for PCP intoxication, the constellation of nystagmus, ataxia, and mild hypertension is typically observed even in mild, low-dose PCP intoxication. Treatment.[aibolita.com]
  • Overdose causes a withdrawn state of depersonalization and disassociation; when doses are higher still, disassociation can become severe and response to external stimuli is impaired, with combativeness, ataxia, dysarthria, muscular hypertonicity, nystagmus[merckmanuals.com]
  • This is frequently seen with blurred vision, drooling, ataxia, nausea, vomiting, and dizziness. High doses of PCP, such as those exceeding 200 mg can lead to seizures, coma, and even death (Kumar, Fitz-Gerald, Kablinger, & Arnold, 2010).[theravive.com]

Workup

  • Urine Toxicology and Laboratory Testing Generally when a patient appears to have PCP intoxication, regular laboratory workup should include renal function, fluid balance, electrolyte abnormalities, hypoglycemia, lactic acidosis, serum creatine phosphokinase[theravive.com]
T Wave Inversion
  • Electrocardiogram showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Subsequently, ECG changes resolved coincidentally with the resolution of chest pain.[ncbi.nlm.nih.gov]
Biphasic T Wave
  • Electrocardiogram showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Subsequently, ECG changes resolved coincidentally with the resolution of chest pain.[ncbi.nlm.nih.gov]

Treatment

  • Abstract The history, symptoms, diagnosis and treatment of phencyclidine hydrochloride (PCP) intoxication and the pharmacology of PCP are reviewed.[ncbi.nlm.nih.gov]
  • Treatment depends on the stage of intoxication.[ncbi.nlm.nih.gov]
  • The modern treatment of phencyclidine intoxication, namely aggressive acidification and diuretic therapy, can enhance the risk of acute renal failure in patients with rhabdomyolysis.[ncbi.nlm.nih.gov]
  • This combination may have a specific antipsychotic role in the emergency treatment of PCP psychosis.[ncbi.nlm.nih.gov]
  • They also know about the various treatment options that are available - like psychotherapy and counseling. Unlike some others, they offer online treatment for help with an addiction to PCP.[gomentor.com]

Prognosis

  • Course and Prognosis. Complete recovery from PCP intoxication is the rule in the absence of major medical complications.[aibolita.com]
  • Even patients with confirmed acute myocardial infarction have a favorable prognosis, possibly because of their relatively young age and good underlying health ( 42 ).[basicmedicalkey.com]
  • Prognosis Relapse and return to PCP use is common, even among people who have experienced severe medical and psychiatric complications from the drug.[minddisorders.com]

Etiology

  • Psychiatric symptoms that persist beyond a few days suggest an etiology other than stimulant use ( 24, 33, 34 ). Transient psychotic symptoms during periods of abstinence (“flashbacks”) have been reported among methamphetamine users ( 35 ).[basicmedicalkey.com]

Pathophysiology

  • Neurological complications of drug abuse: pathophysiological mechanisms. Eur J Neurol 2000;7:595–606; Schuckit MA. Drug and alcohol abuse. A clinical guide to diagnosis and treatment, 6th ed. New York: Springer, 2006; Tashkin DP.[basicmedicalkey.com]

Prevention

  • NOTHING – other than the fear of "taking a stand" – prevented these authors from offering a CONCLUSION strong enough to help to make a difference and save some lives.[charlydmiller.com]
  • For intoxication and PCP-induced psychotic disorder, although resolution of current symptoms and signs is paramount, the long-term goal of treatment is prevention of relapse to PCP use.[aibolita.com]
  • Treatment and aftercare will provide the skills and support someone in recovery will need to live a life of sobriety and prevent relapse.[drugabuse.com]
  • Staff may administer activated charcoal to prevent further absorption of any drugs from the digestive tract into the person’s system. Treatment of any seizures. Seizures will be controlled with medications. Heart monitoring.[recovery.org]
  • You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.[medlineplus.gov]

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