Phencyclidine Blood Concentrations in DRE Cases (original) (raw)

Phencyclidine Intoxication Case Series Study

Journal of Medical Toxicology, 2014

Background Phencyclidine (PCP) is a synthetic compound derived from piperidine and used as an anesthetic and hallucinogenic. Little has been recently published regarding the clinical presentation of PCP intoxication. PCP use as a recreational drug is resurging. Objective Our objective was to describe clinical findings in patients presenting to the emergency department (ED) under the influence of PCP. Methods This was a case series study conducted at a tertiary care center with an annual census of 100,000 patients/year. Emergency physicians, residents, physician assistants, and research assistants identified patients with possible PCP intoxication. Self-reported PCP use, report by bystanders or Emergency Medical Services (EMS) staff, was used in this process. A structured data collection form was completed, documenting both clinical and behavioral events observed by the treating team during the ED visit. Results We collected data on 219 patients; 184 were analyzed; two patients were excluded secondary to incomplete data. The mean age of patients was 32.5 years (±7 years) with 65.2 % being males. PCP use was self-reported by 60.3 % of patients. Of the 184 patients, 153 (83.1 %) received a urine drug screen (UDS); 152 (98.7 %) were positive for PCP. On arrival, 78.3 % of patients were awake and alert, and 51.6 % were oriented to self, time/date, and place. Mean physiological parameters were the following: heart rate 101.1 bpm (±24.3), RR 18.9 bpm (±3.4), BP 146.3 (±19.4)/86.3 (±14.0) mmHg, 36.9°C (±0.5), and pulse oximetry 98.2 % (±1.9). Clinical findings were the following: retrograde amnesia in 46 (25 %), horizontal nystagmus in 118 (64.1 %), vertical nystagmus in 90 (48.9 %), hypertension in 87 (47.3 %), and agitation in 71 (38.6 %). Concomitant use of at least one other substance was reported by 99 (53.8 %) patients. The mean length of stay in the ED for all subjects was 261.1 (±172.8) minutes. Final disposition for 152 (82.6 %) patients was to home. Of the 184 patients, 14 (7.6 %) required admission; 12 were referred to Crisis Response Center.

Diagnosis and treatment of chronic phencyclidine (PCP) abuse

PsycEXTRA Dataset, 2000

Since the last Technical Review on phencyclidine (PCP) held by the National Institute on Drug Abuse was published in the NIDA Research Monograph series in 1978, there has been an explosion of new knowledge about drug actions in brain, including those of phencyclidine and related compounds, and during the same period, a new epidemic of PCP abuse has arisen in a few population centers in the country, resulting in greater clinical expertise in treating PCP abuse and PCP psychoses. In reports published in this Monograph, based on a Technical Review that was held May 7-9, 1985, at NIDA, both basic and clinical aspects of PCP abuse are discussed in detail by leading experts in each area.

Characteristics of 68 chronic phencyclidine abusers who sought treatment

Drug and Alcohol Dependence, 1981

An analysis of 68 phencyclidine (PCP) users who sought treatment reveals that chronic compulsive, daily use occurs and that intravenous use is relatively common. Twenty-five (37%) subjects considered themselves to be addicted to PCP and 19 (28%) desired medication to assist withdrawal. Unwanted behaviors under the influence of PCP were common and primarily related to memory loss, or acts which resulted from loss of impulse control.

The Phencyclidine-Intoxicated Driver

Journal of Analytical Toxicology, 1979

A summary of case histories from 50 phencyclidine-intoxicated drivers is given. Blood phencyclidine concentrations and symptoms of each of these subjects at the time of observation are included. No correlation was observed between the level of impairment and the blood phencyclidine concentration. The analyses were conducted with a gas chromatograph-mass spectrometer by use of select-ion monitoring utilizing deuterated phencyclidine as the internal standard.

Two Fatal Intoxications Involving 3-Methoxyphencyclidine

Journal of Analytical Toxicology

3-and 4-methoxyphencyclidine (3-MeO-PCP, 4-MeO-PCP), structural analogs of phencyclidine (PCP), were among the first legal PCP alternatives to show up on the novel psychoactive substances (NPS) market in Europe in the 2000s. Their structural similarities to PCP and ketamine likely contribute to their demonstrated dissociative anesthetic effects. Limited information exists in the literature about toxic and lethal concentrations of these drugs in biological samples. This case report presents the first two death cases in Washington State in which 3-MeO-PCP was identified. Alkaline drug screen analysis by gas chromatography-mass spectrometry (GC-MS) revealed a peak with a retention time similar to PCP and base peak of m/z 230. Certified reference materials for 3-and 4-MeO-PCP were obtained and the isomers were able to be distinguished based on different retention times and mass spectra. A quantitative GC-MS method was developed and validated for casework, utilizing a dynamic range of 10-1,000 ng/mL and a limit of detection of 1 ng/mL. Postmortem (peripheral/central) blood samples were analyzed using this method and the resulting concentrations were 0.63 and 3.2 mg/L of 3-MeO-PCP. Methamphetamine (0.11 mg/L) was additionally detected in the blood of one of the decedents; while the second decedent was additionally positive for ethanol (0.047 g/100 mL), bupropion (1.8 mg/L), delorazepam, paroxetine and mitragynine. The results presented in this case report are higher than previously reported concentrations in fatal cases, but the presence of polysubstance abuse is consistent with previously reported NPS intoxications. Both of these individuals were in drug rehabilitation facilities prior to their deaths; however, users continue to be drawn to 3-MeO-PCP due to its dissociative effects and its accessibility on the internet.

Nitrogen-phosphorous detection of phencyclidine in blood serum

Journal of Pharmaceutical Sciences, 1982

A method for quantitating phencyclidine in the blood serum of rhesus monkeys with a solvent extraction procedure followed by gas chromatography with nitrogen-phosphorous detection is reported. Phencyclidine was extracted with ether from 0.5 ml of serum (pH 13.5) made basic with 2M NaOH, followed by back-extraction into 0.5 M sulfuric acid. After the addition of 2 M sodium hydroxide, phencyclidine was extracted into a small volume of ether for concentration and injection into the gas chromatograph. The limit of quantitation of phencyclidine in serum was 5 ng/ml. Recovery averaged 51.9 f 4.3%. Standard curves were linear between 5-50 nglml and 100-2000 ng/ml. Comparison between serum and aqueous standards indicated no interference by serum components in the extraction procedure. Pentobarbital, caffeine, and the monohydroxy metabolites of phencyclidine did not interfere with the analysis. This procedure is a rapid and sensitive method for determination of serum phencyclidine levels in animal studies requiring analysis of large numbers of samples. Keyphrases 0 Phencyclidine-analysis using gas chromatography with nitrogen-phosphorous detection, rhesus monkey blood serum 0 Gas chromatography-nitrogen-phosphorous detection of phencyclidine in rhesus monkey blood serum Drugs of abuse-phencyclidine, analysis using gas chromatography with nitrogen-phosphorus detection, rhesus monkey blood serum

Clinical vs. Laboratory Identification of Drugs of Abuse in Patients Admitted for Acute Poisoning

Clinical Toxicology, 2006

Objective. The extent of drug abuse in patients admitted for self-poisonings is uncertain. The aim of this study was to assess the pattern of drugs of abuse among patients admitted for acute poisoning according to age and gender, and to study the concordance between the clinical assessments by the physicians on duty and the drug analyses. Methods. Prospective cross sectional study of all patients (n = 405, 52% males, median age 31 years) treated for acute poisoning in our department during one year (2001). The physician on-call classified type of drug of abuse by history and clinical assessment. This was later compared to urine and blood samples analysed for ethanol, benzodiazepines, opiates, cocaine, ecstasy, GHB, amphetamine and cannabis. Results. In 320 admissions (79%), the comparison between clinical diagnosis and laboratory analyses could be performed. A total of 478 drugs were suspected and 621 were found. The main toxic agents found were benzodiazepines (49.7%), ethanol (40.3%), opiates (35.3%), cannabis (23.8%) and amphetamine (21.3%). Ninety-two had used drugs of abuse. The agreement between clinical assessments and laboratory findings was best for GHB and ethanol (kappa = 0.43), and for opiates (k = 0.38). For benzodiazepines and cannabis, the concordance was poor (k = 0.18 and 0.10, respectively). However, the correct clinical evaluation for these substances was 59% and 77%, respectively. Conclusions. Drugs of abuse were more frequently found than suspected clinically. Benzodiazepines, ethanol and opiates were most common. The agreement between clinical assessment and drug analyses was moderate to low. Physicians seem to underestimate the use of these drugs.

Stability of Phencyclidine in Stored Blood

Clinical Toxicology, 1981

The widespread use of PCP among drug abusers prompted this laboratory to develop a sensitive and specific method for the analysis of PCP in blood and other biological specimens in 1976 [1]. Since that time this laboratory has analyzed more than 900 blood samples which proved positive for PCP. Symptoms associated with the blood concentrations in 50 intoxicated driver cases have been described in the literature .