Phencyclidine

CAS RN: 77-10-1

Treatment Overview

0.4.2 ORAL/PARENTERAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Treatment for mild to moderate toxicity includes minimizing external stimulus, and the use of benzodiazepines for agitation. Antipsychotics may be considered in cases of acute psychosis.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) For severe toxicity, including hyperthermia and psychomotor agitation, high-dose benzodiazepines may be required. If symptoms do not improve, sedation, paralysis and intubation may be indicated. For hyperthermia, control agitation and enhance evaporative heat loss by keeping the skin moist and using fans. Ice water immersion can be used in severe cases. Benzodiazepines can be used for seizures; add barbiturates or propofol if seizures persist. Aggressive fluid resuscitation and supportive care should be used in cases of metabolic acidosis, rhabdomyolysis, and multisystem organ failure.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Prehospital charcoal is typically not recommended in PCP ingestion because of the risk of abrupt changes in mental status.
    • 2) HOSPITAL: Gastric lavage is not indicated for PCP ingestion. Activated charcoal can be offered, but should be given to cooperative, awake alert patients. It should be used with caution as mental status can deteriorate. Overall it is not likely to affect the course of PCP intoxication
  • D) AIRWAY MANAGEMENT
    • 1) Definite airway management may be needed if CNS depression develops. It may also be needed if large doses of sedatives are needed to decrease the sympathomimetic stimulation.
  • E) ANTIDOTE
    • 1) None
  • F) ENHANCED ELIMINATION PROCEDURE
    • 1) Dialysis or other methods of enhance elimination are not recommended. Urinary acidification will increase the excretion of PCP but the risk of systemic acidosis exceeds the potential benefit and it is not recommended. Continuous nasogastric suction has also been advocated but may increase the risk of aspiration or injury in a patient with altered mental status, so it should not be used.
  • G) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Adults who are asymptomatic after a low dose ingestion can be watched at home provided a sober adult can monitor them.
    • 2) OBSERVATION CRITERIA: Any symptomatic patient, and a patient with a self-harm ingestion, and any exposed child should be sent to an emergency department for evaluation, treatment and monitoring.
    • 3) ADMISSION CRITERIA: Patients with severe or prolonged symptoms, or requiring medication treatment should be admitted for further care.
    • 4) CONSULT CRITERIA: Consult a medical toxicologist or poison center for any large and/or severely symptomatic exposures. Child protective services should be involved for exposed children. Consider referral for substance abuse counselling as appropriate.
  • H) PITFALLS
    • 1) Not aggressively treating psychomotor agitation and hyperthermia. Placing patient in physical restraints for psychomotor agitation without proper sedation. Not investigating other etiologies of altered mental status (such as traumatic head injury or meningitis).
  • I) TOXICOKINETICS
    • 1) Absorption is fast via the typical routes of administration: insufflation or ingestion. It is primarily metabolized by the liver via oxidative hydroxylation, after hepatic metabolism, it is excreted by the kidneys. Half-life is about an hours after small doses but can be very prolonged after large doses (7 hours to more than 50 hours).
  • J) DIFFERENTIAL DIAGNOSIS
    • 1) Other arylcyclohexylamines (eg, ketamine), analogs of PCP, other stimulants (eg, amphetamines/methamphetamines), cocaine, MDMA, hallucinogenics such as LSD, peyote, and anticholinergic agents (eg, Jimson weed)
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