Generation Z: Adolescent Xenobiotic Abuse in the 21st Century.

NMDA receptor antagonists such as ketamine, PCP, MXE, and DXM produce dissociative effects by blocking glutamate at the NMDA receptor and also affect monoamine neurotransmitters, opioid receptors, and nitric oxide synthase. DXM is the most commonly abused NMDA receptor antagonist among adolescents in the United States. Patients who abuse these substances typically show sympathomimetic and neuropsychiatric symptoms. Treatment is symptomatic and supportive, including benzodiazepines, propofol, fluids, antiemetics, aggressive cooling, and respiratory support.

Study at a glance

Abstract

NMDA receptor antagonists include the prescription medication ketamine, the illicit xenobiotics PCP, MXE, and other novel PCP analogs, and the OTC medication DXM. The NMDA receptor antagonist most commonly abused by adolescents in the United States is DXM. These xenobiotics cause dissociative effects by non-competitively inhibiting the action of glutamate at the NMDA receptor. Additionally, these agents modulate the actions of monoamine neurotransmitters, agonize opioid receptors, and inhibit nitric oxide synthase. Patients typically present with sympathomimetic and neuropsychiatric clinical manifestations after abuse of NMDA receptor antagonists. Treatment is generally symptomatic and supportive. Interventions include benzodiazepines, propofol, fluids, antiemetics, aggressive cooling, and respiratory support.