Phencyclidine toxicity: Difference between revisions
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*Synthetic piperidine derivative, structurally similar to [[ketamine]] | *Synthetic piperidine derivative, structurally similar to [[ketamine]] | ||
*NMDA inhibitor, at high doses, can also act as norepinepherine/dopamine reuptake inhibitor, and interact with opioid, acetylcholine, and voltage-gated ion channel receptors | *NMDA inhibitor, at high doses, can also act as norepinepherine/dopamine reuptake inhibitor, and interact with opioid, acetylcholine, and voltage-gated ion channel receptors | ||
*Dissociative anesthetic | |||
*Smoked, ingested, or injected | *Smoked, ingested, or injected | ||
*Sometimes combined with tobacco, marijuana ("wet"), crack cocaine, or other drugs | *Sometimes combined with tobacco, marijuana ("wet"), crack cocaine, or other drugs | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Drugs of abuse types}} | |||
==Evaluation== | ==Evaluation== | ||
*Usually clinical diagnosis | *Usually clinical diagnosis | ||
*UDS: false positive screens for PCP can result from dextromethorphan, | *UDS: false positive screens for PCP can result from [[dextromethorphan]], [[diphenhydramine]], [[doxylamine]], [[ibuprofen]], [[meperidine]], [[tramadol]], [[venlafaxine]]) | ||
*Evaluate for dangerous effects of drug: | *Evaluate for dangerous effects of drug: | ||
**Occult trauma | **Occult trauma | ||
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**End-organ damage due to [[hypertensive emergency]] | **End-organ damage due to [[hypertensive emergency]] | ||
*Evaluate for other causes of presentation (e.g. other drugs, infection, endocrine/metabolic disorders, other causes of [[AMS]]) | *Evaluate for other causes of presentation (e.g. other drugs, infection, endocrine/metabolic disorders, other causes of [[AMS]]) | ||
==Management== | ==Management== | ||
Revision as of 01:58, 2 May 2017
Note: this page is about the drug phencyclidine. For the infection, see PCP pneumonia
Background
- Also known as: PCP, "angel dust", "dippers", "supergrass", "whack", "rocket fuel"
- Synthetic piperidine derivative, structurally similar to ketamine
- NMDA inhibitor, at high doses, can also act as norepinepherine/dopamine reuptake inhibitor, and interact with opioid, acetylcholine, and voltage-gated ion channel receptors
- Dissociative anesthetic
- Smoked, ingested, or injected
- Sometimes combined with tobacco, marijuana ("wet"), crack cocaine, or other drugs
Clinical Features
- Onset/duration of action dependant on route of administration; onset usually ~5 minutes if snorted, usually lasts 4-6 hours but can be longer if high dose
- Symptoms can fluctuate from CNS depression to excitation
- Wide range of symptoms due to PCP's cholinergic, anticholinergic, and sympathomimetic properties
- Nystagmus (very common), ataxia
- Hypertension, hypertensive crisis
- Dissociation
- Feelings of strength, invulnerability, hallucinations
- Agitation, unpredictable behavior, violence
- Tachycardia
- Dystonia, muscle rigidity
- Hyperthermia
- Excited delirium
- Seizure
- Coma or apparent comatose state (if very dissociated)
Differential Diagnosis
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
Evaluation
- Usually clinical diagnosis
- UDS: false positive screens for PCP can result from dextromethorphan, diphenhydramine, doxylamine, ibuprofen, meperidine, tramadol, venlafaxine)
- Evaluate for dangerous effects of drug:
- Occult trauma
- Rhabdomyolysis
- Hypoglycemia
- Hepatic injury due to hyperthermia
- End-organ damage due to hypertensive emergency
- Evaluate for other causes of presentation (e.g. other drugs, infection, endocrine/metabolic disorders, other causes of AMS)
Management
- Physical restraints only if danger to self and others
- Sedation: IV benzodiazepines
- Seizures: benzodiazepines, may require propofol and intubation for status epilepticus
- Active cooling if hyperthermic
- Hypertension: usually responds to benzos, but can use nitroprusside if severe/refractory
- IV fluids for rhabdomyolysis
Disposition
- Discharge if only minor medical complications and behavior normalizes