Benzylpiperizine

OVERVIEW

  • hallucinogenic stimulant with similar effects to amphetamines and MDMA
  • once studied as an antihelminthic agent but abandoned due to side effects
  • taken by oral, intravenous, insufflation routes
  • liquid base form is corrosive
  • Risk assessment: > 400mg ingestion requires observation

TOXICODYNAMICS

  • reuptake inhibitor of serotonin > noradrenaline and dopamine
  • alpha2 adrenoceptor antagonist
  • serotonin agonist — 5HT2B =hallucinations , 5HT2A = peripheral effects (e.g. GI symptoms), 5HT1 -> headaches

TOXICOKINETICS

  • bioavailability uncertain
  • hepatic metabolism
  • renal elimination with t1/2 = 5.5 hours

CLINICAL FEATURES

Neurological

  • euphoria, confusion/agitation, anxiety, tremor, seizures

Cardiovascular

  • tachycardia, palpitations, chest pains, dysrhythmias

Other

  • GI upset, fever, hepatotoxicity, rhabdomyolysis

INVESTIGATIONS

  • screening tests — APAP level, ECG, glucose
  • UEC — hyponatremia
  • others as indicated (e.g. cardiac markers, CK, CT head if headache, FND or seizure)

MANAGEMENT

  • treat as for amphetamine toxicity
  • benzodiazepines for agitation, seizures and hypertension
  • phentolamine +/- SNP/ GTN infusions for refractory hypertension
  • treat cardiovascular emergencies as per usual protocols but avoid beta-blockers (risk of unopposed alpha-agonism)

References and Links

  • Gee P, Richardson S, Woltersdorf W, Moore G (2005). Toxic effects of BZP-based herbal party pills in humans: a prospective study in Christchurch, New Zealand (PDF). N Z Med J 118 (1227): U1784. PMID: 16372033

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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