The patient is agitated and tremulous. He is given diazepam 5 mg IV, after which his heart rate is 159 and blood pressure is 128/86. He is given a second dose of diazepam 5 mg IV and two liters of IV normal saline. After the second dose of diazepam, he is calm, and the restraints are removed. Hospitalization is arranged, but on reevaluation, he is improving rapidly. He is discharged four hours after arrival following resolution of symptoms. At the time of discharge, he is ambulatory and conversant. He has no recollection of coming to the emergency department.

Patient 2 is an 18-year-old female who is awake and looking around the room but unable to communicate. She does say a few words, but they are either unintelligible or out of context. There are no visible signs of trauma.

Her temperature is 37.3°C, heart rate 108, respirations 22, and blood pressure 120/65. She is confused and also has dilated pupils. This patient is the first to mention the drug. With repeated questioning, she utters, “B-25.” When she improves to the point that she can communicate, she reports dysphoria and visual hallucinations. Later, she denies dysphoria and reports euphoria instead. The urine drug screen is negative. The WBC is normal. She is given 2 liters of normal saline. She is discharged four hours after arrival following resolution of symptoms.

Patient 3 is a 19-year-old male. He was found supine on the floor of the residence, where he was noted to be occasionally screaming and thrashing. Upon arrival, his temperature is 37.2°C, heart rate 114, respirations 22, and blood pressure 126/67. He is confused and also has large 5 mm nonreactive pupils. Documentation from the examining physician includes: “He is lying on the gurney looking straight up in the ceiling. He has a smile on his face. He does not appear combative. He does not interact with me.” Significant laboratory studies include CO2 20 mmol/L and a WBC of 28,900. Urine drug screen is negative.

He is lying on the gurney looking straight up in the ceiling. He has a smile on his face. He does not appear combative. He does not interact with me. Significant laboratory studies included CO2 20 mmol/L and a WBC of 28,900.

He never looks uncomfortable. He does not communicate initially, but when he improves and is able to communicate, he reports euphoria and visual hallucinations. He is discharged three hours after admission following resolution of symptoms.