0071643192.pdf

TOXICOLOGY

SYMPTOMS/EXAM

■ Altered perception of reality (including pain perception) without loss of

consciousness

■ CNS effects

■ AMS, hallucinations (lower doses)

■ Coma, seizures (higher doses)

■ Tachycardia, hypertension, hyperthermia

■ Nystagmus (vertical or rotatory)

■ Increased secretions

■ Muscular rigidity

TREATMENT

■ Supportive care

■ Aggressive cooling for hyperthermia

■ Sedation to control agitation and hyperthermia

■ Place patient in a quiet room with minimal stimulation.

■ Evaluate for concomitant injuries/infections.

KETAMINE

■ PCP derivative with similar presentation and management

■ “K-hole”: Overdose/adverse reaction consisting of severe hallucinations,

dysphoria, vomiting, and catatonia

DEXTROMETHORPHAN

■ Opioidwith a chemical structure similar to PCP

■ Acts at the same σreceptor as PCP

■ May cross react on PCP urine toxicology screens

■ Less respiratory depression compared to other opioids

■ May precipitate serotonin syndrome

Gamma-Hydroxybutyrate

The only FDA-approved use is for treatment of cataplexy. It is used illicitly by

body-builders, within the rave culture, and in sexual assault.

MECHANISM/TOXICITY

■ Structurally resembles gamma amino butyric acid (GABA) and readily

crosses the blood-brain barrier

SYMPTOMS/EXAM

■ Primarily CNS

■ Euphoria, drowsiness (low doses)

■ Sedation with amnesia (moderate doses)

■ Coma (high doses)

■ Hallmark is coma with episodes of marked agitation on stimulation.

■ Bradycardia, hypothermia, respiratory depression (high doses)

■ Variable neuromuscular activity: Hypotonia, myoclonus, seizures

■ Patients will characteristically awake spontaneously within a few hours after

ingestion and rapidly return to baseline.

Sedation with marked

agitation on stimulation?

Think GHB intoxication.

The duration of GHB coma is

typically short (2–8 hours).