Phencyclidine (PCP) intoxication in children and adolescents
- Michael Levine, MD
Michael Levine, MD
- Assistant Professor of Emergency Medicine
- Department of Emergency Medicine, section of Medical Toxicology
- University of Southern California
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
An overview of PCP intoxication in children and adolescents will be reviewed here. The clinical manifestations and management of PCP intoxication in adults and ketamine poisoning are discussed separately. (See "Phencyclidine (PCP) intoxication in adults" and "Ketamine poisoning".)
PCP (l-l-phenylcyclohexyl piperidine) is a synthetic hallucinogen, that has a variety of street names, including “angel dust,” “dust,” or “sherms” (table 1). These names, along with others, reflect its unpredictable and volatile effects. It was patented in the 1950s as a dissociative anesthetic agent called Sernyl, but was later withdrawn from the market due to adverse effects, including severe agitation, confusion, hallucinations, and prolonged periods of decreased consciousness [1,2]. The recreational use of PCP gained popularity during the 1960s due to its hallucinogenic effects and ease of synthesis. In April of 1979, all legal manufacturing of PCP in the United States was terminated .
In the early 1970s, a laboratory investigation of PCP derivatives led to the discovery of ketamine. Ketamine is 5 to 10 percent as potent as phencyclidine and is now used clinically to induce dissociative anesthesia. Ketamine is also abused as a recreational drug.
Despite a fall in popularity since the 1970s, PCP remains a commonly abused drug that accounts for a significant number of poison center calls and hospitalizations. Early identification and prompt symptomatic treatment are vital to avoid possible sequelae, including self-injury, hyperthermia, rhabdomyolysis, and seizures.
According to the National Institute on Drug Abuse (NIDA) Monitoring the Future study, which tracks reported illicit drug use among high-school students, the recreational use of PCP in the prior year by United States high school seniors decreased from 7 percent in 1979 to 1.1 percent in 2008 [4,5]. However, almost 100,000 children between 11 and 21 years of age in the United States report having used PCP at least once in the prior year, and approximately 1500 annual emergency department (ED) visits for PCP intoxication occur in this age group . Between 2005 through 2011, ED visits for PCP intoxication among those age 12 to 17 years has increased 184 percent . Deaths due to PCP intoxication are uncommon; most fatalities are due to traumatic injury rather than direct drug effects .
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- PHARMACOLOGY AND CELLULAR TOXICOLOGY
- CLINICAL FEATURES OF OVERDOSE
- Physical examination
- - General findings
- - Vital signs
- - Eye findings
- - Neuropsychiatric findings
- - Other findings
- - Complications
- Perinatal exposure
- DIFFERENTIAL DIAGNOSIS
- ANCILLARY STUDIES
- General studies
- Testing for PCP
- Airway, breathing, and circulation
- - Severe agitation
- - Mild to moderate agitation
- Treatment of complications
- - Seizures
- - Hyperthermia
- - Rhabdomyolysis
- - Hypertension
- - Dystonic reaction
- Elimination enhancement
- Child protection
- ADDITIONAL RESOURCES
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS