Hallucinogen Toxicity Workup

  • Author: Joseph A Salomone III, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 28, 2011
 

Laboratory Studies

  • Laboratory evaluation of suspected hallucinogen poisonings usually is not helpful except for correction of metabolic abnormalities (eg, hypoglycemia).
  • Drug screens of patients in the ED rarely affect treatment protocols.
  • Urine drug screens generally detect only some of the hallucinogens, specifically PCP, cocaine, and cannabinoids.
  • Particularly with LSD, the doses ingested to produce effects may be so small as to be essentially undetectable, even with careful assays.
  • In patients with other etiologies of acute mental status changes (eg, CNS infection), a thorough evaluation is indicated, including blood chemistries, CBC, blood cultures, and arterial blood gases.
  • Because a wide variety of medications can induce illusions and hallucinations, a comprehensive drug screen may be indicated to fully evaluate the patient if diagnosis is unclear.
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Imaging Studies

  • Imaging studies are indicated if the physician suspects other causes of altered mental status such as CNS infection or trauma. These studies include CT scanning or MRI of the head. Altered mental status with associated hypertensive crisis or hyperthermia should also prompt CNS imaging because these conditions may be associated with intracerebral pathology.
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Contributor Information and Disclosures
Author

Joseph A Salomone III, MD  Associate Professor and Attending Staff, Truman Medical Centers, University of Missouri-Kansas City School of Medicine; EMS Medical Director, Kansas City, Missouri

Joseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David C Lee, MD  Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM,  Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM, is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

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