Toxicity, Hallucinogens - LSD Treatment & Management

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

Medical Care

The basic tenet of caring for patients who have ingested hallucinogens such as lysergic acid diethylamide (LSD) is reassurance in a calm, stress-free environment. Toxic co-ingestions should be treated with appropriate measures. Rarely, patients need to be either sedated or physically restrained. Excessive physical restraint should be avoided because of the potential complication such as hyperthermia and/or rhabdomyolysis.

Benzodiazepines can safely be given to treat agitation. Neuroleptic medications such as Haldol may have adverse psychomimetic effects and thus are not indicated in patients with LSD intoxication. Patients with a history of psychedelic ingestion may have co-ingested other substances, so the care provider must be aware of other toxidromes.

Because LSD is rapidly absorbed through the GI tract, activated charcoal and gastric emptying are of little clinical value by the time a patient presents to the emergency department (ED). These procedures may even cause the patient to become more frightened and agitated and increase the risk of vomiting with aspiration. Guidelines for detoxification and substance abuse treatment have been established by the Substance Abuse and Mental Health Services Administration.[17]

Massive ingestions should be treated with supportive care, including respiratory support and endotracheal intubation if needed. Hypertension, tachycardia, and hyperthermia should be treated symptomatically. Hypotension should be treated initially with fluids and subsequently with pressors if required.

Ergotism is treated with discontinuation of any inciting drugs and supportive care. Intravenous administration of anticoagulants, vasodilators, and sympatholytics may be useful. The use of balloon percutaneous transluminal angioplasty in severe cases has been reported.[15]

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Consultations

Management of simple hallucinogen intoxications can usually be accomplished without consultation. Patients with a history of substance abuse should be referred for drug treatment. Patients who require admission should have consultation with a medical toxicologist or regional poison control center.

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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

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