Symptoms
Symptoms can vary widely depending on the specific drug, dosage, and individual sensitivity. Common symptoms include:
Neurological: Agitation, confusion, delirium, hallucinations (visual and auditory), dizziness, ataxia (loss of coordination), muscle rigidity or spasms, seizures, coma.
Cardiovascular: Increased heart rate (tachycardia), increased blood pressure (hypertension), or in severe cases, decreased heart rate (bradycardia) and hypotension.
Respiratory: Respiratory depression, difficulty breathing, apnea (cessation of breathing).
Psychiatric: Disorientation, paranoia, anxiety, panic attacks, detachment from reality, catatonia.
Other: Nystagmus (involuntary eye movements), slurred speech, nausea, vomiting, hyperthermia (high body temperature).
Causes
The primary cause is excessive exposure to non-competitive NMDA receptor antagonists. This can occur through:
Overdose: Intentional or accidental ingestion of too much of the drug.
Recreational use: Using the drugs in high doses for their dissociative effects.
Drug interactions: Taking the drug with other substances that enhance its effects or inhibit its metabolism.
Accidental exposure: unintentional ingestion.
Suicide attempt: Intentional ingestion of a lethal dose.
Medicine Used
Treatment primarily focuses on supportive care to manage symptoms:
Airway Management: Intubation and mechanical ventilation may be necessary if respiratory depression is present.
Cardiovascular Support: IV fluids, vasopressors (e.g., norepinephrine) to maintain blood pressure.
Seizure Control: Benzodiazepines (e.g., lorazepam, diazepam) to stop seizures.
Agitation Control: Benzodiazepines or antipsychotics (e.g., haloperidol) to manage agitation and psychosis.
Temperature Management: Cooling measures (e.g., cooling blankets, ice packs) for hyperthermia.
Activated Charcoal: May be considered if the drug was recently ingested, and the patient is alert and able to protect their airway.
There is no specific antidote. Treatment is supportive.
Is Communicable
No, toxicity from non-competitive NMDA receptor antagonists is not communicable. It's a toxicological reaction, not an infectious disease.
Precautions
Precautions focus on preventing exposure and managing potential toxicity:
Safe Storage: Store medications containing these drugs securely, out of reach of children and pets.
Avoid Recreational Use: Avoid using these drugs recreationally.
Prescription Monitoring: If prescribed these medications, follow dosage instructions carefully and inform your doctor about all other medications you are taking.
Education: Educate individuals about the risks associated with these drugs.
Responsible Use: If prescribed, use only as directed by a physician.
Avoid Mixing with other substances: Avoid use with alcohol or other CNS depressants.
How long does an outbreak last?
This is not an infectious disease, so there is no "outbreak." The duration of the effects depends on the specific drug, the dose ingested, and the individual's metabolism. Effects can last from several hours to several days.
How is it diagnosed?
Diagnosis is based on:
History: Information about drug use or potential exposure.
Clinical Presentation: Observing the characteristic symptoms (e.g., agitation, hallucinations, ataxia).
Urine or blood drug screens: To detect the presence of the drug in the system. However, these may not always be readily available or comprehensive.
Ruling out other causes: Excluding other possible medical or psychiatric conditions that could explain the symptoms.
Timeline of Symptoms
The timeline of symptoms can vary:
Onset: Symptoms typically begin within minutes to hours of ingestion or exposure.
Peak: The most severe symptoms usually occur within a few hours.
Resolution: Symptoms gradually subside as the drug is metabolized and eliminated from the body, which can take several hours to days.
Important Considerations
Severity: Toxicity can range from mild to life-threatening.
Individual Variability: Effects can vary widely depending on the individual.
Co-ingestion: Often, these drugs are taken with other substances (e.g., alcohol, other drugs), which can complicate the clinical picture.
Underlying Conditions: Pre-existing medical or psychiatric conditions can influence the severity and course of toxicity.
Prompt Medical Attention: Seek immediate medical attention if you suspect someone is experiencing toxicity from these drugs.