Phencyclidine Toxicity Treatment & Management

  • Author: Patrick L West, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Feb 1, 2011
 

Prehospital Care

  • Evaluate and stabilize the patient's airway, breathing, and circulation (ABCs) including cervical spine immobilization if traumatic injury is suspected.
  • Physical restraints may be required to prevent self-injury and to protect the medical staff. These patients should be monitored closely due to several death reports of PCP-intoxicated patients while being physically restrained.
  • Chemical restraints may also be used. Establish intravenous access and administer benzodiazepines for patients with severe agitation. Intramuscular benzodiazepines are an alternative if intravenous access is unobtainable.
Next

Emergency Department Care

  • After addressing and stabilizing the ABCs, treatment of PCP intoxication starts with initial supportive measures (IV, O2, cardiac monitor). ECG may be indicated to assess for dysrhythmias.
  • Obtain a fingerstick to rule out hypoglycemia.
  • Place patients in a dark, quiet room under continuous observation to minimize environmental stimuli.
  • Consider activated charcoal for oral ingestions and co-ingestions. Multiple doses of charcoal may be beneficial in the case of large overdose. Only one dose of sorbitol should be given, usually with the initial dose. Clinicians should be aware that inappropriate administration of activated charcoal can convert relatively benign exposure (eg, mild PCP intoxication) into a very serious condition (eg, aspiration pneumonia).
  • Extreme violent psychotic behavior requires sedation with parenteral benzodiazepines. Seizures should be treated with benzodiazepines.
  • Haldol (haloperidol) should be reserved for patients with mild, predominately psychotic symptoms, with normal vital signs.
  • Butyrophenones (haloperidol, droperidol) and phenothiazines (eg, chlorpromazine) should be avoided in moderate and severe intoxications because they can lower seizure threshold, cause dystonic reactions, induce hypotension, and worsen anticholinergic symptoms, including hyperthermia.
  • Hyperthermia may be treated by conventional cooling methods.
  • Rhabdomyolysis is treated with intravenous hydration, urine alkalinization, and osmotic/diuretic agents. Possible caveat: There is a theoretical, but clinically unproven, concept of increased PCP reabsorption secondary to the urine alkalinization.
  • For hypertensive emergencies, try to control agitation first with parenteral benzodiazepines. For persistent hypertension, intravenous nitroprusside is the agent of choice. Because of the theoretical concept of unopposed alpha effect (worsening of hypertension) and the availability of other antihypertensive agents (eg, calcium-channel blockers, intravenous nitroglycerin), pure beta-blockade should be avoided. Even labetalol, which has both alpha- (weak) and beta-blocking abilities, can be given only after alpha-blockade with phentolamine is achieved.
  • New research is focused on the development of antibodies to neutralize the toxic effects of PCP.
  • Acute PCP toxicity can usually be managed conservatively with an observation period of a few hours. More serious ingestions may require admission to an intensive care unit for days to weeks.
Previous
Next

Consultations

Consult with a board-certified medical toxicologist or a local poison control center for further recommendations.

Previous
Proceed to Medication
 
 
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.

Robert S Helman, MD  Director, Department of Emergency Medicine, Peninsula Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Lance W Kreplick, MD, FAAEM, MMM  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, FAAEM, MMM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Director of Medical Toxicology, Allegheny General Hospital

Disclosure: Nothing to disclose.

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, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

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.

References

  1. Marx JA, Hockberger RS, Walls RM. Phencyclidine. In: Rosen's Emergency Medicine Concepts and Clinical Practice. 5th ed. St Louis: Mosby Inc; 2002:2146-8.

  2. Poisindex Editorial Staff. Phencyclidine (Acute Toxicity). In: Klasco RK, ed. POISINDEX System. Thomson Micromedex: Greenwood Village, CO; 2005.

  3. OAS Home of Alcohol, Tobacco, and Drug Abuse Statistics. 2006 National Survey on Drug Use and Health (NSDUH). [Full Text].

  4. National Institute on Drug Abuse. 2007 Monitoring the Future (MTF) Survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted by the University of Michigan's Institute for Social Research. [Full Text].

  5. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). Dec 2007;45(8):815-917. [Medline].

  6. Drug Abuse Warning Network. Trends in PCP-Related Emergency Department Visits. January 2004. The Drug Abuse Warning Network Report. Available at www.dawninfo.samhsa.gov.

  7. McCarron MM, Schulze BW, Thompson GA, Conder MC, Goetz WA. Acute phencyclidine intoxication: clinical patterns, complications, and treatment. Ann Emerg Med. Jun 1981;10(6):290-7. [Medline].

  8. Babu K, Boyer E, et al. Emerging drugs of abuse. Clin Pediatr Emerg Med. Jun 2005;6(2):81-4.

  9. Bryson P. Phencyclidine. In: Comprehensive Review in Toxicology for Emergency Clinicians. 3rd ed. Taylor & Francis; 1996:509-16.

  10. Budai B, Iskandar H. Dextromethorphan can produce false positive phencyclidine testing with HPLC. Am J Emerg Med. Jan 2002;20(1):61-2. [Medline].

  11. Goldfrank LR, et al. Phencyclidine and Ketamine. In: Goldfrank's Toxicologic Emergencies. 7th ed. New York: McGraw-Hill; 2002:chap 69.

  12. Greydanus DE, Patel DR. Substance abuse in adolescents: a complex conundrum for the clinician. Pediatr Clin North Am. Oct 2003;50(5):1179-223. [Medline].

  13. Haroz R, Greenberg MI. Emerging drugs of abuse. Med Clin North Am. Nov 2005;89(6):1259-76. [Medline].

  14. Leshner A. Hallucinogens and Dissociative Drugs Including LSD, PCP, Ketamine, Dextromethorphan. National Institute on Drug Abuse Research Report Series. Mar 2001;NIH Pub. No. 01-4209.

  15. Marchei E, Pellegrini M, Pichini S, Martin I, Garcia-Algar O, Vall O. Are false-positive phencyclidine immunoassay instant-view multi-test results caused by overdose concentrations of Ibuprofen, metamizol, and dextromethorphan?. Ther Drug Monit. Oct 2007;29(5):671-3. [Medline].

  16. Mokhlesi B, Leikin JB, Murray P, Corbridge TC. Adult toxicology in critical care: Part II: specific poisonings. Chest. Mar 2003;123(3):897-922. [Medline].

  17. Morocco AP, Osterhoudt KC. Getting "wet" from recreational use of embalming fluid. Pediatr Case Rev. Apr 2003;3(2):111-3. [Medline].

  18. Morris BJ, Cochran SM, Pratt JA. PCP: from pharmacology to modelling schizophrenia. Curr Opin Pharmacol. Feb 2005;5(1):101-6. [Medline].

  19. Rimsza ME, Moses KS. Substance abuse on the college campus. Pediatr Clin North Am. Feb 2005;52(1):307-19, xii. [Medline].

  20. Sena S, Kazimia S, et al. False positive phencyclidine results caused by venlafaxine. Am J Psychiatry. Feb 2007;164(2):349.

  21. Wills B, Erickson T. Drug- and toxin-associated seizures. Med Clin North Am. Nov 2005;89(6):1297-321. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.