Phencyclidine Toxicity (Phencyclidine (PCP))

What is Phencyclidine Toxicity (Phencyclidine (PCP))?

Phencyclidine, commonly known as PCP, is a type of recreational drug often used for its anesthetic effects. PCP comes in a crystal-like powder form, which can be taken by mouth, injected directly into the veins, inhaled, or smoked. The history of PCP can be traced back to 1926 and was initially used as a general anesthetic during the 1950s due to its abilities to ease pain and induce unconsciousness without heavily affecting heart and lung function. The drug, sold under the name Sernyl, was used in surgeries starting in 1963, but later discontinued by 1967 because it led to feelings of unease and hallucinations after surgery.

After 1967, Sernyl was used only for animal treatments. Around the same time, illegal manufacturing of PCP began, and it turned into a popular street drug in San Francisco. Its use became more widespread during the 1970s. You might also know PCP by other street names such as the peace pill, angel dust, crystal joints, rocket fuel, sawgrass, zoom, the sheets, or elephant tranquilizer.

The effects of PCP on the brain and central nervous system can vary greatly depending on how much is taken and how it is administered. It’s essential for medical staff in emergency departments to know how to handle cases of PCP toxicity, as it can lead to complications like muscle breakdown (rhabdomyolysis), low blood sugar (hypoglycemia), seizures, dangerously high blood pressure (hypertensive crisis), coma, and physical injuries.

What Causes Phencyclidine Toxicity (Phencyclidine (PCP))?

The harmful effects of PCP, commonly known as ‘angel dust’, are caused by its usage and misuse.

Risk Factors and Frequency for Phencyclidine Toxicity (Phencyclidine (PCP))

In 2011, emergency department visits due to the use of the drug PCP spiked at 75,538, a significant increase of 400% from the 14,825 cases recorded in 2005, as reported by the Drug Abuse Warning Network. It was observed that the majority of these visits, 72% to be specific, involved the combination of PCP with other drugs including marijuana, cocaine, painkillers, and anti-anxiety drugs.

Most of the visits were from males, accounting for 69% of the cases.
The highest number of these visits was from patients aged between 25 to 34 years old, representing 45% of the total visits.
The age groups 18-24 years old and 35-44 years old each made up 19% of the emergency department visits.
Tragically, the American Association of Poison Control Centers recorded two deaths from PCP in 2012.

Signs and Symptoms of Phencyclidine Toxicity (Phencyclidine (PCP))

PCP, also known as Phencyclidine, is a drug that can cause a variety of symptoms depending on the dosage, how it’s taken, and what other substances are used with it. These symptoms can range from a state of unconsciousness to severe restlessness or even psychosis. Often, patients may not be able to explain their symptoms clearly, so it’s important to gather information from emergency responders, family members, friends, and any other possible witnesses. Understanding different street names for PCP can also be beneficial.

Overall: Symptoms can range from unconsciousness to severe restlessness, overheating, low oxygen levels in the blood.
Head, Eyes, Ears, Nose, and Throat: Rapid eye movement, increased pupil size, decreased pupil size
Heart and Blood Vessels: High blood pressure, rapid heart rate
Nervous System: Mild to severe restlessness, confusion, hallucinations, false beliefs, aggressive behavior, seizures, muscle stiffness, lack of coordination, unconsciousness

It’s also important to do a complete check for any signs of injuries when dealing with PCP intoxication because the hallucinations, decreased sensitivity to pain, and false sense of physical power the drug can cause often lead to self-inflicted injuries.

Testing for Phencyclidine Toxicity (Phencyclidine (PCP))

In an evaluation for suspected PCP (a powerful hallucinogenic drug) toxicity, there are several important tests:

Serum PCP level: This tests the amount of PCP in the blood, but it’s not available at many hospitals.
Fingerstick blood glucose: About 22% of PCP toxicity cases show elevated glucose levels.
Complete blood count: A high white blood cell count (leukocytosis) can occur.
Electrolyte panel: This could reveal elevated levels of BUN and creatinine, substances that indicate how well your kidneys are working.
Creatine kinase: This substance is elevated in 70% of PCP toxicity cases.
Acetaminophen and salicylate levels: These tests are done to see if there are other substances in your system that could cause harm.
Electrocardiogram (ECG): This checks for any abnormalities in the heart’s electrical activity.
CT scan of the head: This could show other reasons for changes in mental status.
Cerebral spinal fluid evaluation: This can help to rule out any brain or spinal cord infections.

A urine test can be useful to check for other substances in the body, although it may not be helpful to identify an acute PCP intoxication. This is because chronic PCP users can test positive weeks after their last use. Also, some medications like methadone, ibuprofen, venlafaxine, and chlorpromazine can give a false positive for PCP. A liver function test could show elevated levels, which is seen in about 50% of PCP toxicity cases. Urinalysis can show elevated levels of myoglobin, a muscle protein. Lastly, imaging studies could reveal any injuries related to PCP intoxication.

Treatment Options for Phencyclidine Toxicity (Phencyclidine (PCP))

Most people can recover from PCP, a type of drug, with proper medical support. This support involves ensuring the patient can breathe properly and has healthy blood circulation. In cases where breathing is severely impaired, the patient might need to be put on a breathing machine.

If a person has consumed a large amount of PCP, or has ingested other harmful substances alongside it, a treatment using activated charcoal might be used. This would need to be done within an hour of the drug being taken. Activated charcoal can help absorb the drug, reducing its effects. The dose for activated charcoal is calculated according to the person’s weight, but it should never exceed 50 grams.

People under the effects of PCP can become agitated, violent, or experience delusions. To control this, they may need to be sedated using medication, or physically restrained. They may also benefit from being in a quiet, dimly lit room. Drugs called benzodiazepines are often used for sedation in these cases. Lorazepam or diazepam can be given either intravenously (into a vein) or intramuscularly (into a muscle). These drugs might need to be given repeatedly every 10 minutes until the patient is adequately sedated. Benzodiazepines can also be used to treat high blood pressure and seizures caused by PCP, as well as overheating due to the agitation caused by the drug.

Patients with mild symptoms can be discharged one to two hours after their symptoms have gone away, providing they don’t have any other medical or behavioral issues. Those with severe symptoms or other medical complications should be admitted to a hospital. If a person who has used PCP doesn’t show any symptoms but has come to the emergency department, they should be observed for at least six hours before being discharged. In cases where a patient’s medical issues are under control, but they still need help with behavioral problems, a psychiatric evaluation might be recommended.

If you’re dealing with the following symptoms, there could be a number of conditions responsible. They might be due to:

Too much alcohol (alcohol intoxication)
Amphetamine abuse
Anticholinergic poisoning
Bipolar disorder
Brain tumors
Cocaine poisoning
Reaction from taking too much diphenhydramine (an antihistamine)
Delirium tremors, usually caused by alcohol withdrawal
Encephalitis, which is a swelling of the brain
Overactive thyroid (hyperthyroidism)
Low blood sugar (hypoglycemia)
Low sodium in the blood (hyponatremia)
Lack of oxygen (hypoxia)
Side effects from LSD use
Malignant hyperthermia, a reaction to certain drugs used during general anesthesia
Effects from MDMA, commonly known as ecstasy or molly
Neuroleptic malignant syndrome, a reaction to antipsychotic drugs
Serotonin syndrome, which can occur with the use of certain drugs
Poisoning from too much salicylate, found in drugs like aspirin
Poisoning from toxic alcohol
Injuries caused by someone or something else or self-inflicted injuries
Meningitis or encephalitis, infections that cause swelling in the brain
Schizophrenia
Sepsis, a serious infection that causes your immune system to attack your body
SSRI toxicity, which can happen if you take too much of a type of drug used to treat depression and anxiety

It’s important for doctors to consider all these possibilities when working out what’s causing your symptoms.

Possible Complications When Diagnosed with Phencyclidine Toxicity (Phencyclidine (PCP))

Hypoglycemia (low blood sugar)
Seizures
Myocardial infarction (heart attack)
Rhabdomyolysis (breakdown of muscle that leads to kidney damage)
Coma
Intraparenchymal hemorrhage (bleeding within the brain)
Subarachnoid hemorrhage (bleeding in between the brain and its protective layers)

Frequently asked questions

Phencyclidine toxicity refers to the harmful effects that occur when a person consumes or is exposed to an excessive amount of PCP, a recreational drug. These effects can include muscle breakdown, low blood sugar, seizures, high blood pressure, coma, and physical injuries.

Phencyclidine toxicity is relatively common, with emergency department visits due to PCP increasing by 400% from 2005 to 2011.

Signs and symptoms of Phencyclidine Toxicity (PCP) can vary depending on the dosage, method of intake, and other substances used in conjunction with it. Here are some common signs and symptoms: - Overall: Symptoms can range from unconsciousness to severe restlessness, overheating, and low oxygen levels in the blood. - Head, Eyes, Ears, Nose, and Throat: Rapid eye movement, increased pupil size, and decreased pupil size. - Heart and Blood Vessels: High blood pressure and rapid heart rate. - Nervous System: Mild to severe restlessness, confusion, hallucinations, false beliefs, aggressive behavior, seizures, muscle stiffness, lack of coordination, and unconsciousness. It is important to note that patients under the influence of PCP may not be able to clearly explain their symptoms, so gathering information from emergency responders, family members, friends, and witnesses is crucial. Additionally, due to the hallucinations, decreased sensitivity to pain, and false sense of physical power caused by PCP, it is important to thoroughly check for any signs of self-inflicted injuries when dealing with PCP intoxication.

Phencyclidine Toxicity (PCP) can occur through the usage and misuse of the drug.

The doctor needs to rule out the following conditions when diagnosing Phencyclidine Toxicity (Phencyclidine (PCP)): - Too much alcohol (alcohol intoxication) - Amphetamine abuse - Anticholinergic poisoning - Bipolar disorder - Brain tumors - Cocaine poisoning - Reaction from taking too much diphenhydramine (an antihistamine) - Delirium tremors, usually caused by alcohol withdrawal - Encephalitis, which is a swelling of the brain - Overactive thyroid (hyperthyroidism) - Low blood sugar (hypoglycemia) - Low sodium in the blood (hyponatremia) - Lack of oxygen (hypoxia) - Side effects from LSD use - Malignant hyperthermia, a reaction to certain drugs used during general anesthesia - Effects from MDMA, commonly known as ecstasy or molly - Neuroleptic malignant syndrome, a reaction to antipsychotic drugs - Serotonin syndrome, which can occur with the use of certain drugs - Poisoning from too much salicylate, found in drugs like aspirin - Poisoning from toxic alcohol - Injuries caused by someone or something else or self-inflicted injuries - Meningitis or encephalitis, infections that cause swelling in the brain - Schizophrenia - Sepsis, a serious infection that causes your immune system to attack your body - SSRI toxicity, which can happen if you take too much of a type of drug used to treat depression and anxiety

The types of tests needed for Phencyclidine Toxicity (PCP) include: - Serum PCP level - Fingerstick blood glucose - Complete blood count - Electrolyte panel - Creatine kinase - Acetaminophen and salicylate levels - Electrocardiogram (ECG) - CT scan of the head - Cerebral spinal fluid evaluation - Urine test - Liver function test - Urinalysis - Imaging studies

Phencyclidine (PCP) toxicity is treated through various methods. Proper medical support is essential, focusing on ensuring the patient's ability to breathe properly and maintaining healthy blood circulation. In severe cases where breathing is impaired, the patient may require the use of a breathing machine. If a large amount of PCP has been consumed or harmful substances have been ingested alongside it, activated charcoal treatment may be used within an hour of drug ingestion. This treatment helps absorb the drug and reduce its effects. Sedation using medication or physical restraint may be necessary to control agitation, violence, or delusions experienced by individuals under the influence of PCP. Benzodiazepines, such as lorazepam or diazepam, are commonly used for sedation. Patients with mild symptoms can be discharged after one to two hours if they have no other medical or behavioral issues, while those with severe symptoms or complications should be admitted to a hospital. If a person who has used PCP shows no symptoms but visits the emergency department, they should be observed for at least six hours before discharge. In cases where medical issues are under control but behavioral problems persist, a psychiatric evaluation may be recommended.

The side effects when treating Phencyclidine Toxicity (PCP) include: - Hypoglycemia (low blood sugar) - Seizures - Myocardial infarction (heart attack) - Rhabdomyolysis (breakdown of muscle that leads to kidney damage) - Coma - Intraparenchymal hemorrhage (bleeding within the brain) - Subarachnoid hemorrhage (bleeding in between the brain and its protective layers)

Emergency physician