Match each specific substance of abuse with its most characteristic clinical presentation and associated findings.
- Phencyclidine (PCP) intoxicationA patient presenting with severe agitation, combative behavior, rotary nystagmus, and a striking lack of pain response to trauma.
- Synthetic cathinone ("bath salts") intoxicationA patient presenting with extreme delirium, paranoia, and sympathetic hyperactivity that persists for 48 to 72 hours; routine toxicology screen is negative.
- 3,4-methylenedioxymethamphetamine (MDMA) intoxicationA patient presenting with euphoria, severe hyperthermia, seizures, and laboratory findings of profound hyponatremia.
- Inhalant (e.g., toluene, aerosols) abuseA patient presenting with transient euphoria, a perioral erythematous rash, and sudden cardiac arrest due to ventricular fibrillation.
- Gamma-hydroxybutyrate (GHB) intoxicationA patient presenting with profound coma and respiratory depression followed by a sudden, agitated awakening a few hours later.
Answer
The correct matches pair PCP with rotary nystagmus and analgesia, synthetic cathinones with prolonged delirium and negative drug screens, MDMA with hyperthermia and hyponatremia, inhalants with perioral rash and cardiac arrhythmias, and GHB with sudden coma followed by abrupt awakening.
Each illicit substance has a unique toxidrome that differentiates it from others in its class. PCP is marked by nystagmus and analgesia; synthetic cathinones cause delirium lasting days that evades standard testing; MDMA is notable for inducing SIADH leading to hyponatremia; inhalants are associated with a perioral rash and sudden myocardial sensitization; GHB presents with a rapidly resolving deep coma.
Step-by-Step Solution
Key Concept
Distinguishing distinct clinical toxidromes and laboratory findings among illicit substances to guide accurate diagnosis and acute management.