PCP Toxicity Treatment & Management

  • Author: Stephan Brenner, MD, MPH; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Mar 21, 2012
 

Medical Care

  • Medical management of phenylcyclohexyl piperidine (PCP), also known as phencyclidine, intoxication is primarily supportive and encompasses treatment of agitated behavior, seizures, and hyperthermia. Therefore, close monitoring of vital signs including temperature is required. If delirium is severe and compromises patient or staff safety, deep sedation with endotracheal intubation may be necessary.
  • The American Academy of Child and Adolescent Psychiatry (AACAP) has established a practice parameter guideline for the assessment and treatment of children and adolescents with substance use disorders.[19]
  • Patients with recent oral use of PCP are candidates for GI decontamination. Activated charcoal (1 g/kg) may be administered and repeated every 4 hours for several doses in most symptomatic patients. Activated charcoal adsorbs PCP and increases its nonrenal clearance.[20] Because mental status can abruptly change, ipecac syrup and GI lavage are not recommended for GI decontamination.
  • Because PCP is a weak base, treatment in the past included acidification of the patient's urine to increase the drug's urinary excretion. This therapy is no longer recommended because severely intoxicated patients are at risk for acidosis and rhabdomyolysis and because the acidification of urine promotes the precipitation of myoglobin within the renal parenchyma. Furthermore, urinary acidification has never been proven to decrease morbidity or mortality. Because of its large volume of distribution, PCP is not effectively removed with hemodialysis or hemoperfusion.
  • Patients intoxicated with PCP have been known to demonstrate violent behavior, and they can often present a danger to the clinical staff. The most important approach to management of agitated behavior is the implementation of safe physical restraints and chemical sedation. Benzodiazepines are usually effective in managing aggressive behavior.
  • Anxiety and agitation can be managed by decreasing external stimuli such as noise, light, and touch. Benzodiazepines are the first means in anxiety treatment, and large doses may be required in severely agitated patients. Benzodiazepines also reduce the occurrence of vivid dreams.
  • Phenothiazines and butyrophenones should be avoided because they may cause significant hypotension, worsen hyperthermia, exacerbate any anticholinergic effect, may induce dysrhythmias, lower the seizure threshold, and cause dystonic reactions. Acute dystonic reactions can be controlled with diphenhydramine.
  • Seizure activity is seen in approximately 3% of patients presenting with PCP intoxication. Seizures should be treated with benzodiazepines, followed by barbiturates, propofol, or both.
  • In some patients severe hypertension with end-organ effects may persist even after the use of benzodiazepines. Phentolamine or nitroprusside are the agents of choice in such cases in order to achieve adequate blood pressure control.
  • Management of hyperthermia should include aggressive mechanical cooling. In profoundly hyperthermic (>40.5°C) patients, rapid sequence induction with endotracheal intubation and paralysis should be considered if no response to more conservative measures is noted.
  • Rhabdomyolysis requires adequate hydration with normal saline in order to maintain a urine output of 2-3 mL/kg/h, as well as close monitoring of creatine phosphokinase (CPK) levels.
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Consultations

  • A medical toxicologist or the staff at a regional poison control center may provide additional information about PCP intoxication and about current patient care recommendations.
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Contributor Information and Disclosures
Author

Stephan Brenner, MD, MPH  Resident Physician, Department of Emergency Medicine, Washington University in St Louis School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Bill Dribben, MD  Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine

Bill Dribben, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Halim Hennes, MD, MS  Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center

Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Ryan J Petersen, MD, to the original writing and development of this article.

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Phenylcyclohexyl piperidine (PCP), also known as phencyclidine, in tablet form. Image courtesy of the US Drug Enforcement Administration.
 
 
 
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