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Concerned parents bring a 29-year-old man to the emergency department. They state that he has been acting strange recently, often staying awake for days on end working, and then staying out all night on the weekends with friends. Today his speech seemed so frantic and thoughts so delusional that his family felt it necessary to bring the patient to the hospital. His vital signs are: temperature 37.0 C (98.6 F), blood pressure 172/98 mm Hg, pulse 110/min, and respirations 20/min. The patient seems agitated and has wide, nonreactive pupils without nystagmus, but otherwise is normal. His symptoms are most likely caused by which of the following drugs?
A. Benzodiazepines
B. Cocaine
C. Heroin
D. Marijuana
E. Phencyclidine
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good all of ya
The correct answer is B. Cocaine can cause a psychotic break or acute mania and presents with symptoms of sympathetic stimulation, including tachycardia, hypertension, and dilated pupils. Cocaine use may present as an unexplained stroke or myocardial infarction in an otherwise young, healthy patient. Because of the short half-life of cocaine, specific detoxification treatments usually are not needed.
Benzodiazepines (choice A) are sedating and are unlikely to present as a manic episode or with sympathetic hyperactivity. Clinical features include slurred speech, incoordination, unsteady gate, and impaired attention, memory, or respiration.
Heroin (choice C) overdose often presents with pinpoint pupils and depressed respiratory drive.
Marijuana (choice D) may make some patients agitated, confused, or just plain hungry, but is unlikely to present with this picture of sympathetic hyperactivity.
Phencyclidine (choice E), also known as PCP, is a stimulant that can cause severe neuropsychiatric effects including catatonia. It is the only drug of abuse that creates vertical nystagmus, a useful clue on physical examination.
