Treatment of Phencyclidine Intoxication

To the Editor.—  The letter by Maurice S. Albin, MD (240:529,1978), deserves further comment in view of the widespread abuse of phencyclidine hydrochloride. Severe intoxication from phencyclidine and its congeners induces coma and respiratory, cardiovascular, and renal complications.¹ The latter are secondary to rhabdomyolysis² resulting from an interaction of phencyclidine, skeletal exertion, and limb restraints, which should not be used. We have been unable to show any global improvement using tetrahydroaminoacridine or another cholinesterase inhibitor, physostigmine, in dogs severely poisoned with phencyclidine (unpublished data, 1979). In patients poisoned with phencyclidine, I recommend the use of urine acidification and symptomatic therapy maintaining vital functions in cases of severe overdose.³ Because phencyclidine has a pK_a of 8.5 to 9.5, 3 pH units lower (5 to 6) will allow most of the phencyclidine in the urine to remain ionized and hence not be reabsorbed by the renal tubules.Although