Clinical findings affecting the nervous system and/or behavior:
(1) coma
(2) altered mental status change (lethargy, confusion, disorientation)
(3) acute toxic psychosis (auditory and visual hallucinations, delusions, catatonia)
(4) acute brain syndrome with delirium
(5) violent reactions
(6) agitation
(7) mild euphoria
(8) seizures
(9) intracranial hemorrhage
(10) nystagmus
(11) ataxia
(12) muscle incoordination
(13) unusual posturing, myoclonic movements or choreoathetoid movements
(14) staring or mutism
Physical findings:
(1) traumatic injuries, which may follow aggressive behavior or falls from height
(2) hyperthermia
(3) hypertension
(4) anticholinergic or adrenergic signs (tachycardia, mydriasis, urinary retention)
(5) cholinergic signs (diaphoresis, miosis, bronchospasm, excessive salivation)
(6) rhabdomyolysis, which may be followed by acute renal failure
(7) aspiration pneumonia
(8) respiratory depression, apnea and respiratory arrest (secondary to depressive effects)
(9) cardiac arrest
If the ingested drug is impure, then toxic effects of the additive(s) may also develop.
The drug is stored in adipose tissue. Metabolism of adipose tissue can result in release from these stores, with recurrent symptoms.
Criteria for hospitalization:
(1) pediatric patient
(2) seizures
(3) hyperthermia
(4) rhabdomyolysis
(5) severe trauma
(6) altered mental status or coma
(7) severe behavioral reaction (psychosis, agitation, violent)
(8) intracranial hemorrhage
(9) respiratory depression, apnea or cardiac arrest
(10) severe hypertension
