Hallucinogens Workup

  • Author: Brooke S Parish, MD; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Jun 23, 2011
 

Laboratory Studies

  • In general, laboratory studies do not play a large role in the diagnosis and treatment of hallucinogen poisoning.
    • Only a few hallucinogenic agents show up on standard toxicological screens. These include MDMA (positive for amphetamines), PCP, and marijuana.
    • Treatment of hallucinogen poisoning is rarely affected by drug screen results.
    • Dextromethorphan (as in Robitussin DM) may cause a false-positive result for the presence of PCP.
  • Metabolic abnormalities should be sought and aggressively treated.
    • MDMA may cause hyponatremia.
    • PCP and MDMA may cause rhabdomyolysis and subsequent myoglobinuric renal failure. Check the creatine kinase level.
    • Always exclude hypoglycemia as a cause of altered mental status.
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Imaging Studies

A CT scan of the head is indicated in all patients with an unexplained alteration in mental status.

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Contributor Information and Disclosures
Author

Brooke S Parish, MD  Associate Professor, Department of Psychiatry, University of New Mexico School of Medicine

Brooke S Parish, MD is a member of the following medical societies: American College of Physicians and American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Michael E Richards, MD, MPA, FACEP  Associate Professor, Department of Emergency Medicine, University of New Mexico School of Medicine

Michael E Richards, MD, MPA, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Scott Cameron, MD  Consulting Staff, Department of Emergency Medicine, Regions Hospital

Scott Cameron, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Ronald C Albucher, MD  Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center

Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Eduardo Dunayevich, MD  Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

References

  1. Erritzoe D, Frokjaer VG, Holst KK, et al. In Vivo Imaging of Cerebral Serotonin Transporter and Serotonin2A Receptor Binding in 3,4-Methylenedioxymethamphetamine (MDMA or "Ecstasy") and Hallucinogen Users. Arch Gen Psychiatry. Jun 2011;68(6):562-76. [Medline].

  2. de la Torre R, Farre M. Neurotoxicity of MDMA (ecstasy): the limitations of scaling from animals to humans. Trends Pharmacol Sci. Oct 2004;25(10):505-8. [Medline].

  3. Wilcox JA, Wilcox AH. Movement disorders and MDMA abuse. J Psychoactive Drugs. Jun 2009;41(2):203-4. [Medline].

  4. SAMHSA. 2003 National Survey on Drug Use and Health. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Available at http://www.oas.samhsa.gov/nhsda/2k3nsduh/2k3Results.htm. Accessed October 30, 2009.

  5. Lin DL, Liu HC, Liu RH. Methylenedioxymethamphetamine-related deaths in Taiwan: 2001-2008. J Anal Toxicol. Sep 2009;33(7):366-71. [Medline].

  6. Erowid. The Vaults of Erowid: Documenting the Complex Relationship Between Humans and Psychoactives [Web site]. [Full Text].

  7. Greene SL, Kerr F, Braitberg G. Review article: amphetamines and related drugs of abuse. Emerg Med Australas. Oct 2008;20(5):391-402. [Medline].

  8. Halpern JH, Sewell RA. Hallucinogenic botanicals of America: a growing need for focused drug education and research. Life Sci. Dec 22 2005;78(5):519-26. [Medline].

  9. Ompad DC, Galea S, Fuller CM, et al. Club drug use among minority substance users in New York City. J Psychoactive Drugs. Sep 2004;36(3):397-9. [Medline].

  10. 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].

  11. Prisinzano TE. Psychopharmacology of the hallucinogenic sage Salvia divinorum. Life Sci. Dec 22 2005;78(5):527-31. [Medline].

  12. SAMSHA. Ecstasy, Other Club Drugs, & Other Hallucinogens. Available at http://www.oas.samhsa.gov/ecstasy.htm.

  13. Tucker JR, Ferm RP. Lysergic acid diethylamide and other hallucinogens. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA, Hoffman RS, eds. Goldfrank's Toxicological Emergencies. 6th ed. Stamford, Conn: Appleton & Lange; 1998:1111-9.

  14. Williams LC, Keyes C. Psychoactive drugs. In: Ford MD, Delaney KA, Ling LJ, Erickson T, eds. Clinical Toxicology. Philadelphia, Pa: WB Saunders; 2001:640-9.

 
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