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Up Cocaine Ketamine LSD MDMA Phencyclidine

"Angel dust"


  • anticholinergic effects
  • opioid effects
  • dopaminergic effects
  • CNS stimulant
  • alpha agonist

Mode of poisoning

  • smoked, snorted, ingested orally, injected IV
  • frequently combined with other drugs (eg ethanol, marijuana, LSD)

Clinical features

  • behavioural disturbance
    • violent
    • bizarre behaviour
    • agitation
  • altered mental status in approximately 1/2, ranges from lethargy to coma
  • nystagmus (vertical and horizontal)
  • pinpoint pupils
  • hypertension
    • hypertensive crisis has been reported
  • generalized convulsions rare
  • muscle rigidity, dystonic reactions, athetosis rare
  • sweating, hypersalivation, bronchospasm and urinary retention uncommon
  • apnoea and cardiac arrest rare
  • may be complicated by rhabdomyolysis, intracerebral haemorrhage or subarachnoid haemorrhage

Consider diagnosis in patient with:

  • fluctuating behaviour, signs of sympathetic overstimulation and vertical nystagmus
  • pinpoint pupils and agitation


  • no role for gastric lavage or emesis
  • activated charcoal
  • haloperidol drug of choice for phencyclidine psychosis, ± benzodiazepine
  • nitroprusside or labetalol for severe hypertension that does not respond to calming strategies
    • beta-blockers contraindicated because unopposed alpha activity may worsen hypertension

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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