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1. Introduction
Ayahuasca is a hallucinogenic tea that is most commonly comprised of the vine Banisteriopsis caapi alone or in combination with other plants such as Psychotria viridis [1]. The hallucinogenic amine N,N-dimethyltryptamine (DMT), usually degraded by monoamine oxidases in the gut, is made orally active when the DMT containing leaves of P. viridis are consumed with the beta-carboline alkaloids present in B. caapi vines. Despite recorded use for centuries in South America as a medicinal agent and a component of religious ceremonies, interest in the psychedelic effects and perceived spiritual effects of ayahuasca has led to its increased use in the United States (US), especially among young adults [2–4]. We present a case of severe agitation following ayahuasca consumption with DMT confirmation.
2. Case Report
A 25-year-old male with history of schizophrenia, prior suicide attempt, and hallucinogen abuse presented to the emergency department (ED) under mental health arrest for altered mental status. Neighbors notified police after he had broken several windows in his home and was creating loud noise and disturbance. They arrived to find him in front of the house and fighting with a cat; he was bleeding from lacerations on his chest caused by the cat’s claws. The patient was subdued with a conducted electrical weapon and restrained in the field for aggressive behavior. In the ED, the patient endorsed suicidal ideation and was reportedly amnestic to the events prior to hospitalization. On physical examination, his blood pressure was 116/71 mm Hg and his pulse was 88 beats per minute. Multiple abrasions were noted on his chest, feet, and hands in addition to a laceration on his forehead, which required sutures. He had mild clonus with 3+ patellar reflexes but was not overtly rigid. His pupils were dilated and he had flushed skin but no diaphoresis. The initial laboratory values were significant for creatine kinase (CK) of 895 IU/L, white blood cell count of 20 k/mm3, and urine immunoassay positive for amphetamines (confirmation negative; cocaine, benzodiazepines, tetrahydrocannabinol, and opiates also negative). A medical toxicology consult was requested and the patient admitted to drinking a...