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Alcohol
7%
3/42
Alprazolam
62%
26/42
Cocaine
2%
1/42
Marijuana
0%
0/42
Phencyclidine
17%
7/42
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This patient with a history of known substance use presents with agitation, disorientation, tachycardia, hypertension, and nystagmus. These features together are suggestive of phencyclidine (PCP) intoxication.Individuals often exhibit psychosis or violent behavior following ingestion of PCP. Common behaviors include those listed above as well as impulsivity, psychomotor agitation, and violence. Physical symptoms are present within one hour of ingestion and include nystagmus, hypertension, tachycardia, numbness, ataxia, dysarthria, muscle rigidity, seizures, and coma. PCP intoxication is a psychiatric emergency, treated by minimizing environmental stimuli and supportive care, often requiring benozidiazepines for severe agitation..Milhorn reviews PCP intoxication, noting that symptoms can be divided into three stages. Psychiatric signs mark the first stage (mild intoxication). Patients are stuporous or comatose in the second stage, and unresponsive in the third stage.Brust reviews substance abuse and movement disorders. Phencyclidine is one of several drugs and toxins that can cause cerebellar problems and movement disorders. It is associated with myoclonus.Illustration A shows data of illicit drug use from the report, "Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings and Detailed Tables". Illustration B illustrates the alterations in vital signs of various drugs.Incorrect Answers:Answer 1: Alcohol may cause nystagmus in some individuals. However, sympathetic stimulation (e.g. hypertension, tachycardia, diaphoresis) and profound agitation would not be expected. Answer 2: Alprazolam is a benzodiazepine medication and is a common drug of abuse. However, alprazolam is a GABA receptor agonist and causes somnolence and respiratory depression in large doses. Sympathetic hyperactivity and agitation would not be expected.Answer 3: Cocaine intoxication may present with signs of sympathetic stimulation as in this patient. However, patients are not often profoundly agitated and disoriented. Nystagmus is also a specific feature pointing to phencyclidine as the source of this patient's symptoms. Answer 4: Marijuana is a common drug of abuse and may cause mild tachycardia in some patients. However, profound agitation and disorientation would not be expected. Bullet Summary: Phencyclidine intoxication presents with signs of sympathetic hyperactivity, agitation, disorientation, and nystagmus.
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