A Review of Thirty Cases of Rhabdomyolysis-Associated Acute Renal Failure among Phencyclidine Users

Arylcyclohexamines (Ketamine, Phencyclidine, and Analogues)

“…Intravenous access is required for all patients who present with significant acute arylcyclohexamine toxicity, with blood taken for electrolytes, glucose, lactate, urea, and creatinine. In the significantly agitated patient, rhabdomyolysis may be a feature, with myoglobin-associated acute kidney injury as a cause of high morbidity and mortality associated with PCP intoxication in particular [332,333]. When present, it should be treated aggressively with intravenous fluids (see chapter on Rhabdomyolysis in the Critically Poisoned Patient).…”

“…However, the risk of inducing systemic acidemia outweighs the potential benefits (Grade III recommendation). Urinary acidification also has the potential to increase the risk of acute tubular necrosis in patients with rhabdomyolysis [333,343]. Furthermore, while renal clearance of PCP has been shown to be increased by up to 23 % following urinary acidification, this accounts for only 1 % of total PCP clearance due to the majority of its clearance being via hepatic metabolism [109,344].…”

The general approach to the poisoned patient

“…Urinary acidification for weak bases, such as phencyclidine or amphetamines, is not recommended due to risk of myoglobinuria and rhabdomyolysis. 68 Hemodialysis enhances removal of substances with low molecular weight, low protein binding, small volumes of distribution, and high water solubility. Hypotension may preclude its use.…”