A patient presents with mydriasis, paranoia, hallucinations, extreme aggression, and superhuman strength. What substance may they have ingested?

The symptoms of mydriasis (dilated pupils), paranoia, hallucinations, extreme aggression, and superhuman strength are most consistent with the ingestion of PCP (phencyclidine). PCP is known for causing profound changes in perception, mood disturbances, and aggressive behavior. It acts as a dissociative anesthetic and can produce hallucinatory effects, which align well with the patient's presentation of paranoia and hallucinations.

The extreme aggression and reported "superhuman strength" are particularly characteristic of intoxication with PCP, as it can lead to a significant alteration in muscle coordination and pain perception, allowing individuals to exhibit unusual physical feats. The mydriasis observed is also a classic side effect associated with PCP use.

In contrast, while LSD can cause hallucinations and altered states of perception, it typically does not result in extreme aggression or superhuman strength. Cocaine can lead to aggression and increased energy, but it does not commonly produce hallucinations or the degree of altered perception described. Marijuana is unlikely to cause such intense symptoms, and its effects are usually more sedative and calming rather than leading to aggressive behavior. Overall, the profile of symptoms aligns most accurately with PCP use.