Journal of Clinical Toxicology
Open Access

Cardiac Arrest in Patient with Phencyclidine (PCP) Intoxication

Sonia Fnu¹, Mukesh Kumar^2*, Hamza Ahsan³ and Abbasi Abdul Rahman Ahemd^{3 *}Correspondence: Mukesh Kumar, Griffin Hospital and Montefiore Medical Center, New York, USA, Email:

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Introduction

Phencyclidine is a dissociative anesthetic and tranquilizer that at present is being abused as psychedelic and hallucinogenic agent with increasing frequency. PCP is considered as less addictive among all the illicit substances due to its unique mechanism of action and more CNS excitement than depressant. Also mortality from PCP is less compared to most common substances such as opioids, cocaine, alcohol. We present a Case report of a patient with PCP intoxication leading to cardiac arrest and death.

Case Presentation

A 39 years old man with a history of substance abuse was brought to ER by EMS after the wife found the patient unresponsive. EMS arrived at home, found the patient in an asystole and initiated CPR. Total of 4 epinephrine, defibrillated twice as the patient has ventricular fibrillation. The patient then had PEA after a second defibrillation. Transported to the emergency department with CPR ongoing, the patient achieved Return to spontaneous circulation after 40 minutes. In the emergency department the patient again had cardiac arrest 4 rounds of epinephrine 1 mg administered along with 200 J shock and amiodarone 300 mg, ROSC achieved in 24 minutes. More than one hour later, while still in the ED, the patient had another episode of pulselessness, during which 2 epinephrine 1 mg were administered, shocked with 200 J, ROSC achieved after 10 minutes. Initial labs as outlined below. Initial EKG with Junctional Rhythm. Echocardiography with severe Left ventricular dysfunction. Chest x-ray clear. CT head done initially unremarkable no stroke or anoxic damage but repeat CT after 48 h hour reveals severe global anoxic brain injury. Clinical examination revealed ecchymosis and swelling of the upper arm and forearm, no palpable pulses at the level of the wrist and hand was cold. Emergent bedside fasciotomy done for compartment syndrome. Unfortunately patients developed multiorgan failure, respiratory failure, renal failure, shock liver, cardiogenic shock and passed on day 6th of hospitalization (Table 1).

Table 1: Labs on presentation.

Results and Discussion

Phencyclidine (PCP, “angel dust”) is an infamous hallucinogenic sought for its ability to induce the illusion of euphoria, omnipotence, superhuman strength, and social and sexual prowess. Ketamine is the only one authorized for medical use [1]. Phencyclidine is available in multiple forms powder, tablet and crystals and liquids. Most commonly it is found in PCP-laced marijuana and inhalation accounts for 70% of usage [2-4]. PCP can produce CNS stimulation and depression through its different effects in the CNS. Clinical effects are dose dependents. At Low dose it causes euphoria, disorientation combativeness with high dose it causes muscle contraction, hyperthermia, convulsions, stupor and coma [5]. Muscle tone becomes exaggerated and patients exhibit hyperreflexia and myoclonic. Complications of this hypertonic muscle activity include hyperthermia and rhabdomyolysis [6]. Non-traumatic causes of death include cardiopulmonary arrest, intracranial hemorrhage in hypertension, and hyperkalemia secondary to rhabdomyolysis [7]. Our patient had multiple cardiac arrests. Initial evaluation showed hyperkalemia with potassium of 11.7 with severe rhabdomyolysis creatine Kinase of 80,000. Patient went into cardiac arrest with asystole and ventricular fibrillation. It could be possible that our patient had seizures from PCP overdose and developed compartment syndrome that led to severe rhabdomyolysis and hyperkalemia. Hyperkalemia is well known to cause various cardiac arrhythmia from ventricular fibrillation to asystole. Cardiac rhythm complications are directly proportional to level of hyperkalemia. Patients with values above 10 meq/L have high mortality from cardiac arrest. There have been few case reports reporting severe Rhabdomyolysis with PCP intoxication [8,9].

Conclusion

Though PCP is not directly associated with high mortality as compared to other drugs such as opioids cocaine alcohol but it can be lethal through its indirect effect such as mentioned above like hyperthermia and rhabdomyolysis. Most of the time patients are not aware of the complete toxic profile of the uncommon drug like PCP and related compounds. It is very important to educate the patients who have a history of multiple substance abuse regarding the potentially lethal complication of PCP and should be discussed that even if taken occasionally it can be lethal.

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