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Key Features

  • The mechanism of toxicity and the clinical effects vary for each substance

Clinical Findings

  • Anticholinergic delirium

    • Dilated pupils

    • Flushed skin

    • Dry mucous membranes

    • Tachycardia

    • Urinary retention

  • LSD

    • Marked visual hallucinations and perceptual distortion

    • Widely dilated pupils

    • Mild tachycardia

  • Phencyclidine (PCP) can produce fluctuating delirium and coma, often with vertical and horizontal nystagmus

  • Toluene and other hydrocarbon solvents (eg, butane, trichloroethylene)

    • Euphoria

    • Delirium

    • Potentially fatal dysrhythmias

  • Other drugs used for their psychostimulant effects include

    • Synthetic cannabinoid receptor agonists

    • Salvia divinorum

    • Synthetic tryptamines and phenylethylamines

    • Mephedrone and related cathionone derivatives

Treatment

  • For recent ingestions, administer activated charcoal, 60–100 g orally or via gastric tube, mixed in aqueous slurry

  • Treat anticholinergic delirium with physostigmine salicylate, 0.5–1.0 mg intravenously, not to exceed 1 mg/min

  • Caution: Bradyarrhythmias and convulsions can occur with physostigmine use

  • Treat dysphoria, agitation, or psychosis from LSD or mescaline intoxication with

    • Lorazepam, 1–2 mg orally or intravenously

    • Haloperidol, 2–5 mg intramuscularly or intravenously

    • Another antipsychotic drug (eg, olanzapine or ziprasidone)

  • Monitor patients who have sniffed solvents for cardiac dysrhythmias; β-blockers (eg, propranolol, 1–5 mg intravenously, or esmolol, 250–500 mcg/kg intravenously, then 50 mcg/kg/min by infusion) may be used

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