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Anticholinergic delirium
Dilated pupils
Flushed skin
Dry mucous membranes
Tachycardia
Urinary retention
Plants and mushrooms containing hallucinogenic indoles (eg, mescaline, psilocybin, LSD) may cause
Phencyclidine (PCP) and ketamine can produce a dissociative state often associated with vertical and horizontal nystagmus
Toluene and other hydrocarbon solvents (eg, butane, trichloroethylene, “chemo”)
Other drugs used for their psychostimulant effects include
Synthetic cannabinoid receptor agonists
Salvia divinorum
Synthetic tryptamines and phenylethylamines
Mephedrone and related cathinone derivatives
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Emergency and supportive measures
Maintain a patent airway and assist breathing if necessary
Treat coma, hyperthermia, hypertension, and seizures
For recent large ingestions, administer activated charcoal, 60–100 g orally or via gastric tube, mixed in aqueous slurry
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; beta-blockers (eg, propranolol, 1–5 mg intravenously, or esmolol, 250–500 mcg/kg intravenously, then 50 mcg/kg/min by infusion) may be more effective than lidocaine or amiodarone