Pediatric emergency medicine trisk 3144 3144
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Given risk of rhabdomyolysis with use of these agents, testing should include
creatine kinase, renal function tests, and a U/A in patient with clinical symptoms
of intoxication. If tests for muscle enzymes and/or renal function are abnormal
and the urine has a positive test for hemoglobin without red blood cells, the
patient should be assumed to have rhabdomyolysis and should be treated
accordingly (see Chapter 100 Renal and Electrolyte Emergencies ). Although
urine acidification (pH less than 5.0) enhances the urinary excretion of PCP, it
should not be performed because it exacerbates metabolic acidosis and may
promote deposition of myoglobin in renal tubules.
Hallucinogens: LSD, Psilocybin, Mescaline, and Tryptans
CLINICAL PEARLS
These drugs can produce a number of mental status changes,
including hallucinations, delusions, and paranoid ideation.
Patients may sustain significant injuries while under the influence of
these drugs, thus careful assessment for secondary injuries is
warranted.
No single characteristic distinguishes hallucinogens from other classes of
centrally active drugs such as anticholinergics, cocaine, and amphetamines.
However, the psychedelic state is characteristically described as consisting of
vivid and unusual visual experiences with diminished control over what is
experienced. Images and sensations take on profound meaning, and the ability to
differentiate oneself from the environment is decreased. Most drugs in this
category are related to the indolealkylamines (psilocybin, dimethyltryptamine
[DMT], diethyltryptamine), lysergamides (LSD), or phenylethylamines
(mescaline, methylenedioxymethamphetamine [MDMA, Ecstasy, Molly],
synthetic cathinones, the 2C class of drugs).
Current Evidence. Hallucinogens act at multiple sites in the CNS. The “2C” drugs
(4-iodo-2,5-dimethoxyphenylethylamine and 4-iodo-2,5-dimethoxy-N -(2methoxybenzyl) phenethylamine) are hallucinogenic phenethylamines initially
developed for research purposes that have subsequently emerged as drugs of
abuse. The pharmacologic action that these drugs seem to have in common is as
agonists of presynaptic serotonin-2 receptors (which modulate serotonin release
into the synaptic cleft). Most of these agents have structural similarities to
