PCP Toxicity Workup

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

Laboratory Studies

  • In general, routine laboratory workup in patients who present with toxicity involving phenylcyclohexyl piperidine (PCP), also known as phencyclidine, should be focused on renal function, fluid balance, electrolyte abnormalities, hypoglycemia, lactic acidosis, serum creatine phosphokinase (CPK) levels, and urine myoglobin levels.
  • Quantitative laboratory analysis is generally not very helpful because serum and urine levels do not reflect the drug's vast lipid storage, nor does the precise serum concentration correlate with the clinical effect. Results of toxicologic urine screening may remain positive for several weeks because of PCP's large volume of distribution.
  • Qualitative plasma or urine levels may help establishing the diagnosis but should be interpreted with care. Urine screening for PCP should be part of the diagnostic workup in children and infants presenting with acute dystonic reactions.[18]
  • Ketamine levels, as well as norketamine levels, can be determined in urine; however, these specific tests are generally not readily available and are not clinically useful. PCP may cross-react with ketamine assays.
  • Diphenhydramine and dextromethorphan (which are also frequently abused N-methyl-D-aspartate [NMDA] receptor antagonists) can produce false-positive urine drug screens for PCP because of their similar chemical structures.
  • Other useful tests to determine the presence of rhabdomyolysis, renal dysfunction, and hypoglycemia include measurements of electrolytes, glucose, BUN, creatinine, and total creatine kinase levels, as well as a urinalysis (myoglobin). An ABG measurement may be indicated to assess the occurrence of metabolic acidosis and hypoxemia. A urine pregnancy test is indicated in female patients of childbearing age.
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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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