LSD Toxicity Clinical Presentation
- Author: Stephan Brenner, MD, MPH; Chief Editor: Timothy E Corden, MD more...
History
- Although hallucinogen use, such as lysergic acid diethylamide (LSD) use, rarely results in presentation to health care facilities, patients that present to the emergency department (ED) typically do so after acute panic reactions, massive ingestions, or unintentional ingestions (children or adults who have unknowingly ingested the drug). Altered perception can lead to behavioral toxicity, in which judgment is impaired and prevents an appreciation of the dangers in the environment, resulting in situations in which injury can occur.
- Patients who present after recent hallucinogen abuse are often oriented and capable of providing a history of drug ingestion. The subjective effects of LSD use, or "trip," widely vary with the user's preconceived beliefs and expectations about the drug and the environment in which the ingestion occurred. In general, hallucinogens can intensify the current mood when the drug is taken; pleasant feelings can be augmented to euphoric feelings with the achievement of new insights or an expanded consciousness. Negative feelings, personal flaws, or depressive symptoms can be amplified to a dysphoric experience. Changes produced in consciousness lead to loss of boundaries between the user and the environment. Users often report intensification or alterations of colors and sound (synesthesia) and the perception that common objects appear novel, fascinating, or awe-inspiring.
Physical
- Patients generally present with a combination of somatic and psychomimetic symptoms:[12]
- Somatic symptoms are usually due to sympathomimetic effects, including mydriasis, hypertension, tachycardia, flushing, sweating, loss of appetite, nausea, dry mouth, drowsiness, sleeplessness, weakness, paresthesias, tremors, and hyperthermia.
- Psychomimetic symptoms can include alterations in mood (euphoria/dysphoria), distorted sense of time, difficulties expressing thoughts and/or focusing on objects, depersonalization, dreamlike feelings, sharpened sense of hearing, synesthesias, and visual hallucinations.
- Patients can be agitated or withdrawn, and adverse reactions are usually seen in inexperienced users or in patients who have unknowingly taken the drug. An unexpected stressful setting can cause an acute panic reaction, even in experienced users. Children can appear agitated, withdrawn, or catatonic. In pediatric cases of known LSD intoxication, parental abuse or neglect must be assumed and investigated.
- Drug-induced persistent psychosis manifests as distorted and disorganized thoughts, dramatic mood swings, mania, depression, vivid visual disturbances, and hallucinations that persist even after the drug effects have ended. Although rare, these symptoms may last for years.
- LSD has been found to be responsible for triggering serotonin syndrome in patients already using precipitating drug combinations (serotonin precursors or agonists, serotonin-release stimulators, selective serotonin reuptake inhibitors [SSRIs], nonselective serotonin-reuptake inhibitors, nonspecific inhibitors of 5-HT metabolism).[13]
- Hallucinogen persisting perception disorder (HPPD) describes spontaneous, repeated or continuous recurrences of sensory distortions including hallucinations, visual disturbances, seeing false motion in the peripheral vision field, bright colored flashes, halos, or trails attached to moving objects. These perceptual symptoms remain unchanged for long periods and often last for years after initial drug use. Such patients often present after previous negative work-up for brain damage or psychiatric disorders.[14, 3]
- Ergotism related to LSD ingestion is an extremely rare but reported complication. It is thought to be caused by ergot-derived LSA containing ergotlike precursors. Eponymously termed “Saint Anthony’s fire,” ergotism refers to ergot-induced vasoconstriction that leads to burning pain from limb ischemia, dry gangrene of fingers and toes, tissue desquamation, peripheral pulselessness, sensation loss, and edema. Ergotism can also present with convulsive symptoms leading to headache, paresthesias, seizures, and other CNS effects, which are often preceded by GI symptoms like nausea, vomiting, and diarrhea. LSD-induced ergotism often presents as vasoconstrictive effects in combination with hallucinations, mania, or psychosis.[15]
- In rare cases, increased morbidity or even mortality have been associated with complications of hyperthermia such as rhabdomyolysis,[16] myoglobinuric renal failure, hepatic necrosis, and disseminated intravascular coagulopathy.
- Generally, LSD-related deaths result from behavioral toxicity. One reported case involved a user that was killed after attempting to stop a train barehanded. The extreme agitation of a “bad trip” can lead to suicide or unintentional death as a result of fleeing from negative hallucinations.
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