eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Phencyclidine: Follow-up

Author: Patrick L West, MD, Clinical Instructor, Medical Toxicology Fellow, Department of Emergency Medicine, Oregon Health and Sciences University; Staff Physician, Department of Emergency Medicine, Portland Veterans Affairs Medical Center
Coauthor(s): Nathanael J McKeown, DO, Assistant Professor, Oregon Health and Science University; Medical Toxicologist, Oregon Poison Center; Attending Physician, Emergency Medicine, Portland Veteran Affairs Medical Center, Oregon Health and Science University
Contributor Information and Disclosures

Updated: Jan 21, 2009

Follow-up

Further Inpatient Care

  • Any patient with evidence of unrelenting agitation, hypertensive crisis, hyperthermia, seizures, respiratory depression, rhabdomyolysis, or severe traumatic injuries should be admitted to the hospital, and possibly to an intensive care setting if indicated.
  • Consider a psychiatric evaluation for substance abuse counseling and/or suicidal ideations.

Further Outpatient Care

  • Consider referral to a drug rehabilitation program. Repeated use of PCP can result in addiction, and abrupt discontinuation of the drug can produce withdrawal symptoms, including craving, confusion, and depression.2

Complications

  • Chronic PCP toxicity results in cognitive deficits and mood disorders. Patients can develop speech impediments and also suffer from dysphoria, depression, anxiety, and psychosis.
  • Occult traumatic injuries must be ruled out. Perform a thorough physical examination on all patients under the influence of PCP.

Prognosis

  • Patients who present with rhabdomyolysis, renal failure, seizures, hyperthermia, hypertensive crises, and traumatic injuries tend to have worse outcomes.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • The acute toxicity of PCP is often misdiagnosed because of its similarity to schizophrenic episodes. In fact, PCP-induced psychosis may respond to antipsychotics, which may further confound the diagnosis.
  • Do not rely on the urine toxicology screen to diagnose acute PCP intoxication. Chronic PCP users can have positive test results for weeks after their last use. Cases of false-positive results for PCP have also been reported with many agents, including diphenhydramine (Benadryl) and dextromethorphan, agents in over-the-counter cough formulations that can produce clinical effects similar to PCP when taken in high doses.
  • Failure to diagnose or address CNS infection, hypoglycemia, hyperthermia, traumatic injuries, or rhabdomyolysis is medical malpractice.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Nicole S Johnson, MD, and Mark A Silverberg, MD, to the development and writing of this article.



More on Toxicity, Phencyclidine

Overview: Toxicity, Phencyclidine
Differential Diagnoses & Workup: Toxicity, Phencyclidine
Treatment & Medication: Toxicity, Phencyclidine
Follow-up: Toxicity, Phencyclidine
References
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References

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Further Reading

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Keywords

phencyclidine toxicity, PCP, PCP overdose, phencyclidine overdose, angel dust, peace pill, crystal joint, supergrass, wack, rocket fuel, KJ, illy, elephant tranquilizer, embalming fluid

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Contributor Information and Disclosures

Author

Patrick L West, MD, Clinical Instructor, Medical Toxicology Fellow, Department of Emergency Medicine, Oregon Health and Sciences University; Staff Physician, Department of Emergency Medicine, Portland Veterans Affairs Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Nathanael J McKeown, DO, Assistant Professor, Oregon Health and Science University; Medical Toxicologist, Oregon Poison Center; Attending Physician, Emergency Medicine, Portland Veteran Affairs Medical Center, Oregon Health and Science University
Nathanael J McKeown, DO is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Lance W Kreplick, MD, MMM, FAAEM, FACEP, Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC
Lance W Kreplick, MD, MMM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Fred Harchelroad, MD, FACMT, Chair, Department of Emergency Medicine, Director of Medical Toxicology, Department of Emergency Medicine, Associate Professor, Allegheny General Hospital
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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