Phencyclidine death

Burns, R.S., and Lerner, S.E. Phencyclidine deaths. J Am Coll Fmera Phvs 7 135-141, 1978. 

In seven cases of poisoning with phencyclidine, death followed a hypertensive crisis (9). In one case an acute episode of hypertension resulted in coma and blindness (10). 

Noguchi, T.T. and Nakamura, G.R. Phencyclidine-related deaths in Los Angeles County. J Forensic Sci 23 503-510, 1978. 

Eastman, J.W., and Cohen, S.N. Hypertensive crisis and death associated with phencyclidine poisoning. JAMA 231 1270-1271, 1975. 

Bailey, D.N., Shaw, R.F., and Guba, J.J. Phencyclidine abuse Plasma levels and clinical findings in casual users and in phencyclidine-related deaths. J. Anal. Toxicol. 2 233-237, 1978. 

There have been two further reports of sudden death after the use of droperidol to sedate agitation secondary to cocaine and phencyclidine intoxication (26). Both patients were restrained by the police and were then given droperidol, either 5 mg (a 33-year-old obese man) or 10 mg (a 22-year-old man). The first patient stopped breathing 10-15 minutes later, while being transported to the emergency department he was pulseless and couldn t be resuscitated. The other patient was unresponsive on arrival at the emergency department, with agonal respirations and no detectable pulse after 30 minutes of resusci-tative efforts he was pronounced dead. 

The psychoactive effects of phencyclidine are stimulant and similar to the effects of hallucinogens. Hallucinations are often bizarre, frightening, and challenging. Aggressive behavior, usually with amnesia, is common. Self-destruc-tive actions are also seen. Overdosage is associated with paresthesia, slurred speech, ataxia, and later catatonia, dilated pupils, and coma, with tachycardia, hypertension, and dysrhythmias. Seizures and deaths have occurred (SED-11, 86 4). 

Of 19 deaths associated exclusively with phencyclidine intoxication, 13 were due to asphyxia by drowning or trauma (22). In two cases the probable cause of death was primary respiratory depression accompanied by seizure activity. A secondary drug effect or concurrent disease may have contributed to the deaths of the remaining four individuals. 

Toxicity. Blood concentrations in the region of 0.1 pg/ml produce abnormal behaviour and concentrations of about 0.3 pg/ ml or more cause severe toxic symptoms which may be followed by death although there is considerable intersubject variation. Many deaths have been due, not to the toxic effects of phencyclidine itself, but to the effects of irrational behaviour caused by the drug. In 53 cases of death reported in the literature as not directly due to phencyclidine, blood concentrations ranged from 0.01 to 2.1 pg/ml (mean 0.36) in 22 of these cases urine concentrations ranged from 0.1 to 10.6pg/ml (mean 2.1) alcohol was also present in a number of these cases. 

Hypoglycemia can be seen. Rhabdomyolysis, acute renal failure, disseminated intravascular coagulation, liver necrosis, and traumatic injury are reported complications. The anesthetic dose of phencyclidine is 0.25 mg kg intravenously. Doses of 1-5 mg are purported to cause euphoria and numbness, 5-10 mg cause excitation and hallucinations, and 20 mg or more cause coma and serious toxicity or death. Plasma concentrations of phencyclidine vary widely after overdose. Phencyclidine crosses the placenta resulting in hyperirritability, tremors and hypertonia, depressed reflexes, and nystagmus in neonates. 

Ketamine can cause attention deficits and memory problems. At higher doses, users may experience symptoms similar to those seen with phencyclidine (PCP) use, such as hallucinations, dream-like states, or delirium. Even higher doses of Ketamine may cause high blood pressure, depression, and severe breathing problems, which may lead to death. 

Glutamic acid Most neurons in the brain are excited by glutamic acid. Subtypes of glutamate receptors include the NMDA (A-methyl-o-aspartate) receptor, which is blocked by phencyclidine (PCP) and ketamine. NMDA receptors appear to play a role in synaptic plasticity related to learning and memory. Excessive activation of NMDA receptors following neuronal injury may be responsible for cell death. Glutamate metabotropic receptor activation can result in G-protein-coupled activation of phospholipase C or inhibition of adenylyl cyclase. 

Phencyclidine (PGP, known as angel dust ) is an especially dangerous drug with a unique pattern of effects. At low doses, its effects resemble those of alcohol. With higher doses, hallucinations set in and behavior can become hostile and self-destructive, promoting psychoses that can last for weeks. Physical effects include seizures, coma, and death from cardiac arrest. 

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