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Serotonin
6%
9/142
Cannabinoid
7%
10/142
GABA
8%
11/142
NMDA
72%
102/142
Norepinephrine
5%
7/142
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This patient's presentation is consistent with phencyclidine (PCP) intoxication, which is characterized by violent/aggressive behavior, hallucinations, slurred speech, ataxia, and vertical/horizontal nystagmus. PCP acts as NMDA-receptor antagonist. PCP is a street-drug that is also known as angel dust; it may be used to lace other recreational drugs such as crack cocaine or marijuana. In addition to those symptoms mentioned above, intoxication with PCP is characterized by belligerence, impulsiveness, fear, homicidality, psychosis, delirium, seizures, psychomotor agitation, and tachycardia. Ketamine acts in a similar fashion to PCP as an NMDA antagonist. Milhorn discusses the diagnosis and management of phencyclidine (PCP) intoxication. PCP intoxication involves three clinical stages: 1) mild intoxication involving mainly psychiatric signs and symptoms, 2) moderate intoxication characterized by stuporous or comatose state with intact deep pain response, and 3) severe intoxication where patients have no response to deep pain stimuli. Management of the PCP-intoxicated patient should vary based on the stage and severity of intoxication. MacNeal et al. assessed the efficacy and safety of using haloperidol to pharmacologically restrain aggressive and violent patients in the emergency department setting. They found that haloperidol does not cause harm in PCP-intoxicated patients, while it is beneficial in protecting both patients and ED staff working with agitated and violent patients intoxicated with PCP. Illustration A depicts PCP's site of inhibition in the NMDA-receptor complex. Incorrect Answers: Answer 1: LSD acts at the serotonin receptor. Amphetamines stimulate serotonin release. Cocaine inhibits serotonin re-uptake. Answer 2: Marijuana acts at cannabinoid receptors; this patient's presentation is not consistent with marijuana intoxication, which is characterized instead by euphoria, paranoid delusions, perception of slowed time, increased appetite, dry mouth, hallucinations, and amotivational syndrome. Answer 3: Benzodiazepines and ethanol act on GABA receptors. This clinical presentation is not consistent with intoxication with these depressant substances. Answer 5: Amphetamines stimulate NE release. Cocaine inhibits NE re-uptake.
4.8
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