Mescaline toxicity

Background

Peyote

• Psychedelic phenethylamine , naturally occurring in the peyote cactus (Lophophora williamsii) and other cacti
• Similar to, but chemically distinct from and less potent than LSD
• Thought to be a serotonin agonist
• Sold as dried cactus parts or "buttons"
• Used in religious ceremonies by some indigenous Central and South american peoples.

Clinical Features

• Onset 30-60 minutes, lasts 5-12 hours (though wide individual variability)
• Euphoria, energy, esoteric/spiritual experiences
• Altered sensorium, altered sense of time, extreme focus or distractibility, hallucinations
• Nausea/vomiting, abdominal pain
• Adrenergic stimulation: mydriasis, mild tachycardia, mild hypertension, hyperthermia
• Dizziness, headache

Differential Diagnosis

Hallucinations

Serotonin-Like Agents

• Lysergic acid diethylamide (LSD)
• Psilocybin ("magic mushrooms")
• N,N-Dimethyltryptamine (DMT)
• 5-methoxy- dimethyltryptamine (5-MeO-DMT)
• 25C-NBOMe

Enactogens

• Designer amphetamines
• Bath salts
• Ecstasy (MDMA)
• Mescaline (peyote)
• Synthetic cannabinoids

Dissociative Agents

• Phencyclidine (PCP)
• Ketamine
• Dextromethorphan
• Nitrous oxide

Plant-based Hallucinogenics

• Marijuana
• Salvia
• Absinthe
• Isoxazole Mushrooms
• Hawaiian baby woodrose (Argyreia nervosa)
• Hawaiian woodrose (Merremia tuberosa)
• Morning glory (Ipomoea violacea)
• Olili- uqui (Rivea corymbosa)

Organic causes

• Delirium
• Intracranial mass to occipital or temporal lobes
• Encephalitis, limbic encephalitis, anti-NMDA receptor encephalitis
• Migraine
• Seizure
• Hypocalcemia/Hypercalcemia
• Rift valley fever
• Rabies
• Syphilis
• Vitamin B7 deficiency
• Pellagra
• Dementia
  • Parkinson's Disease

Other Toxicologic Causes

• Alcohol withdrawal
• Anticholinergic Toxicity
• Tricyclic (TCA) Toxicity
• Synthetic cannabinoids
• Inhalant abuse
• Nitrogen narcosis
• GHB withdrawal
• Hydrocarbon toxicity
• Heavy metal toxicity
• Multiple medications: montelukast, doxapram, hyoscyamine, tizanidine, peramivir, amantadine, rimantadine, bromocriptine, methylergonovine, benztropine, doxepin, voriconazole, acyclovir, valacyclovir, ganciclovir, cimetidine, penicillin G Procaine, clarithromycin, metoclopramide
• Inhalant abuse

Psychiatric Causes

• Schizophrenia, schizoaffective disorder, schizophreniform disorder
• Depression with psychotic features
• Bipolar disorder
• Charles Bonnet Syndrome (in the visually impaired)

Dissociative drugs

• Dextromethorphan
• Ketamine
• Nitrous oxide
• Phencyclidine (PCP)
• Alcohol Withdrawal
• Anticholinergic Toxicity
• Tricyclic (TCA) Toxicity
• Ertapenem Toxicity
• Encephalitis
• Hypocalcemia/Hypercalcemia
• Schizophrenia, schizo-affective Disorder
• Dementia
• Delirium
• Migraine
• Seizure
• Parkinson's Disease

Evaluation

• Not detected on routine drug screens
• Evaluate for other organic causes of hallucinations or hyperadrenergic symptoms
• Evaluate for co-ingestions

Management

• Supportive care
• Not usually associated with significant morbidity/mortality

See Also

• Hallucinogens

References

• Tintinalli’s
• https://erowid.org/chemicals/mescaline/mescaline.shtml