eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Toxicology

Toxicity, Hallucinogens - LSD: Follow-up

Author: Stephan Brenner, MD, MPH, Resident Physician, Department of Emergency Medicine, Washington University in St Louis School of Medicine
Coauthor(s): Bill Dribben, MD, Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine
Contributor Information and Disclosures

Updated: Apr 16, 2009

Follow-up

Further Inpatient Care

  • Patients who have used lysergic acid diethylamide (LSD) and have only minor agitation can usually be treated safely in the emergency department (ED) with observation and supportive care until symptoms have resolved.
  • Patients with persistent or unexplained psychotic symptoms should have a psychiatric evaluation.
  • Admission should be considered if the etiology for the patient's abnormal behavior is unclear or if toxic co-ingestions are suspected.

Complications

  • In massive overdoses, respiratory arrest, coma, emesis, hyperthermia, autonomic dysregulation, and bleeding disorders can occur.
  • The patient's altered perceptions can lead to behavioral toxicity, in which the patient does not appreciate the dangers in the environment and may be injured. The extreme agitation of a bad trip has been known to lead to suicide or to unintentional deaths as users have tried to flee from their hallucinations.
  • Long-term complications may include prolonged psychotic reactions, severe depression, or an exacerbation/unmasking of a preexisting psychiatric illness. Hallucinogen persisting perception disorder (HPPD) is a Diagnostic and Statistical Manual IV (DSM-IV) diagnosis, in which patients who are not intoxicated experience symptoms (flashbacks) that occurred during the use of LSD. Patients can have both perceptual and visual disturbances during these brief episodes. HPPD may last several months; however, some patients report these experiences for as long as 5 years and often have an underlying psychiatric illness.

Prognosis

  • Most users of LSD voluntarily decrease or stop its use over time.
  • LSD is not considered an addictive drug because it does not produce compulsive drug-seeking behavior; however, LSD does produce a physiologic tolerance, requiring subsequent increased doses to achieve the same effect.

Patient Education

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Amanda Wood, MD, to the original writing and development of this article.



More on Toxicity, Hallucinogens - LSD

Overview: Toxicity, Hallucinogens - LSD
Differential Diagnoses & Workup: Toxicity, Hallucinogens - LSD
Treatment & Medication: Toxicity, Hallucinogens - LSD
Follow-up: Toxicity, Hallucinogens - LSD
Multimedia: Toxicity, Hallucinogens - LSD
References
Further Reading
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References

  1. Passie T, Halpern JH, Stichtenoth DO, Emrich HM, Hintzen A. The pharmacology of lysergic acid diethylamide: a review. CNS Neurosci Ther. 2008;14(4):295-314. [Medline].

  2. Fusar-Poli P, Borgwardt S. Albert Hofmann, the father of LSD (1906-2008). Neuropsychobiology. Epub 2008 Sep 18.;58(1):53-4.:[Medline].

  3. NIDA Research Report - Hallucinogens and Dissociative Drugs: NIH Publication No. 01-4209, Printed March 2001. Available at http://www.nida.nih.gov/PDF/RRHalluc.pdf.

  4. DEA Office of Diversion Control, d-Lysergic Acid Diethylamide. Available at http://www.usdoj.gov/dea/concern/lsd.html.

  5. Marona-Lewicka D, Thisted RA, Nichols DE. Distinct temporal phases in the behavioral pharmacology of LSD: dopamine D2 receptor-mediated effects in the rat and implications for psychosis. Psychopharmacology (Berl). Jul 2005;180(3):427-35. [Medline].

  6. Holohean AM, White FJ, Appel JB. Dopaminergic and serotonergic mediation of the discriminable effects of ergot alkaloids. Eur J Pharmacol. Jul 30 1982;81(4):595-602. [Medline].

  7. Nichols DE. Hallucinogens. Pharmacol Ther. Feb 2004;101(2):131-81. [Medline].

  8. US Department of Health and Human Services Department Visits Substance Abuse and Mental Health Services Administration. National Estimates of Drug-Related Emergency. Drug Abuse Warning Network. Available at http://dawninfo.samhsa.gov/files/ED2006/DAWN2k6ED.pdf. Accessed 2006.

  9. Gold MS, Schuchard K, Gleaton T. LSD use among US high school students. JAMA. Feb 9 1994;271(6):426-7. [Medline].

  10. Wu LT, Schlenger WE, Galvin DM. Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths. Drug Alcohol Depend. Sep 1 2006;84(1):102-13. [Medline].

  11. National Institutes of Health, US Department of Health and Human Services. Monitoring the Future: National Results on Adolescent Drug Use. Overview of Key Findings, 2007. Available at http://www.monitoringthefuture.org/pubs/monographs/overview2007.pdf.

  12. Klock JC, Boerner U, Becker CE. Coma, hyperthermia, and bleeding associated with massive LSD overdose, a report of eight cases. Clin Toxicol. 1975;8(2):191-203. [Medline].

  13. Martin TG. Serotonin syndrome. Ann Emerg Med. Nov 1996;28(5):520-6. [Medline].

  14. Halpern JH, Pope HG Jr. Hallucinogen persisting perception disorder: what do we know after 50 years?. Drug Alcohol Depend. Mar 1 2003;69(2):109-19. [Medline].

  15. Raval MV, Gaba RC, Brown K, Sato KT, Eskandari MK. Percutaneous transluminal angioplasty in the treatment of extensive LSD-induced lower extremity vasospasm refractory to pharmacologic therapy. J Vasc Interv Radiol. Aug 2008;19(8):1227-30. [Medline].

  16. Taunton-Rigby A, Sher SE, Kelley PR. Lysergic acid diethylamide: radioimmunoassay. Science. Jul 13 1973;181(95):165-6. [Medline].

  17. Center for Substance Abuse Treatment (CSAT). Physical detoxification services for withdrawal from specific substances. Rockville, MD: Substance Abuse and Mental Health Services Administration; Jan 18, 2006. 41-115.

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Further Reading

  • Brunton L L, Lazo JS, Parker KL. Goodman and Gillman's The Pharmacological Basis of Therapeutics. 11th ed. New York, NY: McGraw-Hill Professional; 2006.
  • Goldfrank L, Flomenbaum N, Lewin N, Howland MA, et al. Goldfrank's Toxicologic Emergencies. 7th ed. New York, NY: McGraw-Hill Professional; 2002.

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Keywords

LSD, lysergic acid diethylamide, hallucinogens, psychedelics, lysergide, "A", acid, Adams, buttons, the beast, blotter, blue chairs, blue cheers, blue mist, brown dot, California triple dip, cube, dot, flat blues, gelatin, green wedge, hawk, Lucy in the sky with diamonds, M and Ms, mescal, microdot, mighty Quinn, mind detergent, Owsley acid, Owsley blue dot, pearly gates, pink wedge, pink Owsley, purple Owsley, Sandoz's, strawberries, sugar cube, sunshine, uncle, vacation, wedding bells, window panes, LSD overdose, LSD poisoning, LSD toxicity, treatment, schizophrenia, synesthesias, good trip, bad trip, hallucinate, hallucinogenic persisting perception disorder, HPPD, flashbacks, respiratory arrest, coma, emesis, hyperthermia, autonomic instability, bleeding disorders, depression, serotonin syndrome, ergotism, Saint Anthony's fire, rhabdomyolysis, hepatic necrosis, myoglobinuric renal failure, disseminated intravascular coagulopathy, DIC

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Contributor Information and Disclosures

Author

Stephan Brenner, MD, MPH, Resident Physician, Department of Emergency Medicine, Washington University in St Louis School of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Bill Dribben, MD, Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine
Bill Dribben, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Halim Hennes, MD, MS, Pediatric Emergency Medicine Research Director, Professor, Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin
Halim Hennes, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Merck Salary Employment

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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