Toxicity, Hallucinogens - LSD Follow-up

  • Author: Stephan Brenner, MD, MPH; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Apr 16, 2009
 

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.
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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.
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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.
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Patient Education

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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.

Specialty Editor Board

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.

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

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

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.

References

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  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].

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  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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Assorted lysergic acid diethylamide (LSD) blotter paper.
Lysergic acid diethylamide (LSD) in assorted pill forms.
 
 
 
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