PART 3 / CH 27
PCP and LSD
Siobhan O’Neill
| PCP | LSD | ||
|---|---|---|---|
| Urine Levels | present/absent | present/absent | |
| Duration of (+) result | Varies widely, 2 days- 2 weeks | ||
| Serum level | not clinically useful | not clinically useful | |
| Duration of (+) result | brief | brief | |
| Acute intoxication: signs and symptoms | Intoxication lasts 4 hours to several days. Unpredictable aggression! Psychosis. Difficulty thinking, sensory disturbance, hyperacusis, feelings of unreality or estrangement, depersonalization, euphoria or affective dullness, apathy. Nystagmus, increased BP and HR, dysarthria, muscle rigidity, Increased motor activity, anorexia, clumsiness, amnesia incr. sedation from alcohol and barbs. At higher doses: Ataxia, lethargy, nausea, vomiting, mental depression | “Trips” usually last 4-6h. Early intoxication occurs in phases: 1. Somatic: (0-60 min.) Tension, lightheadedness, mydriasis, twitching, flushing, tachycardia, hypertension, hyper-reflexia. 2. Nausea, restlessness, dizziness, excitement, detached feelings. 3. Well-being, euphoria, self-confidence. Euphoria may alternate with depression, anxiety (fear of “going mad” or dying); psychosis in some cases. At higher doses, illusions and visual distortions with clear sensorium. | |
| (cont.’d) | PCP | LSD | |
| Complications | Coma: (15%). Hypo/hyperthermia: (2-6%) Seizures: (3%) Rhabdomyolysis -mild: (70%) Rhabdo, ARF (2%) | Impaired judgement and motor incoordination combined with enhanced self-confidence often lead to fatal accidents. | |
| Treatment of acute intoxication. | Supportive/expectant. Quiet, dim room, minimize stimulation. Haldoperidol PRN. Try to avoid restraints (risk of fractures!) Beware of respiratory sedation with use of benzodiazepine. | “Talking down” of patient in a quiet room, with orientation, external focus, and reassurance. Patients require 1:1. Haldol, bdz PRN. | |
| Chronic use | Tolerance, physical dependence. Memory and learning are impaired. | “Hallucinogen persisting perception disorder” (flashbacks) may develop long after even one exposure to LSD. Patients generally don’t believe that flashbacks represent reality. | |
| Withdrawal: signs and symptoms | Vocalizations, bruxisms, oculomotor hyperactivity, diarrhea, piloerection, lethargy, tremors, convulsions. Withdrawal is very uncommon as most are infrequent users. | Resolution of a “trip” is usually rapid. Withdrawal (physical dependence) does not occur. | |
| Treatment of withdrawal | symptomatic | N/A |