LSD Poisoning Clinical Presentation

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Aug 2, 2011
 

History

The most common route of exposure is oral. LSD frequently is sprayed onto small squares of paper (ie, "blotter acid") that are decorated with a variety of patterns. Both the drug and paper are eaten. Current street doses typically are 20-80 mcg, considerably less than those used in the 1960s and 1970s. LSD also is sold as tiny tablets (microdots), thin squares of gelatin (windowpanes), liquid, or powder. It may be insufflated, smoked, injected, used sublingually, or instilled into the conjunctiva.

  • Mental effects develop in 30-90 minutes, peak in 3-5 hours, and last 8-12 hours. These include the following:
    • Feeling of inner tension, often relieved by laughing or crying
    • Multiple, simultaneous emotions, such as joy, rage, terror, or panic
    • Religiosity and a feeling of "oneness with the universe"
    • Possible distorted perception of the passage of time
    • Possible magnification or distortion of sounds
    • Illusions (or hallucinations with high doses)
      • Moving patterns of bright colors on people and objects
      • Geometric images within larger images
      • Trails behind moving objects
      • Halos around objects
      • Shapes blending together or melting like wax
      • Palinopsia (the persistence of a visual image in the brain long after the actual stimulus has gone)[6]
    • Synesthesia or the mixing of sensory perception such that the individual may see sounds or feel colors
  • While the effects of LSD often are considered pleasurable to the user, at times they may be profoundly disturbing, resulting in a "bad trip." Novices as well as seasoned users can experience bad trips. Common manifestations include the following:
    • Panic reaction
    • Amplification of unconscious fears
    • Self-aggression
    • Suicidal or homicidal ideation
    • Fear of going insane or of the inability to return to normal
    • Perception of rapid aging of self or others
    • Profound depression
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Physical

  • Predominantly sympathomimetic effects develop within 5-10 minutes of ingestion. Findings include the following:
    • Profound mydriasis
    • Hyperactive reflexes
    • Tachycardia
    • Hypertension
    • Tremors
    • Vomiting
    • Diarrhea
    • Piloerection
    • Mild pyrexia
    • Seizures (rare and typically with doses >10 mcg/kg)
    • Intact orientation and cognition
  • In massive overdose, additional signs include the following:
    • Coma (very rare)
    • Respiratory arrest
    • Hyperthermia
    • Coagulopathy
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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP  Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, 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.

Coauthor(s)

Alan H Hall, MD, FACEP  Assistant Professor of Emergency Medicine, Division of Toxicology, Texas Tech University Health Sciences Center at El Paso; President, Chief Medical Toxicologist, Toxicology Consulting and Medical Translating Services, Inc

Disclosure: Nothing to disclose.

Specialty Editor Board

Suzanne White, MD  Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine

Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, and Michigan State Medical Society

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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References

  1. Vollenweider FX, Kometer M. The neurobiology of psychedelic drugs: implications for the treatment of mood disorders. Nat Rev Neurosci. Sep 2010;11(9):642-51. [Medline].

  2. González-Maeso J, Sealfon SC. Psychedelics and schizophrenia. Trends Neurosci. Apr 2009;32(4):225-32. [Medline].

  3. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Results from the 2002 National Survey on Drug Use and Health: National Findings. US Department of Health and Human Services. Available at http://www.oas.samhsa.gov/nhsda/2k2nsduh/results/2k2Results.htm#HallLife. Accessed March 25, 2008.

  4. National Institute on Drug Abuse (NIDA). NIDA InfoFacts: High School and Youth Trends. Revised 12/07. National Institutes of Health. Available at http://www.drugabuse.gov/Infofacts/HSYouthtrends.html. Accessed March 25, 2008.

  5. Rickert VI, Siqueira LM, Dale T. Prevalence and risk factors for LSD use among young women. J Pediatr Adolesc Gynecol. Apr 2003;16(2):67-75. [Medline].

  6. Abert B, Ilsen PF. Palinopsia. Optometry. Aug 2010;81(8):394-404. [Medline].

  7. Berrens Z, Lammers J, White C. Rhabdomyolysis After LSD Ingestion. Psychosomatics. Jul 2010;51(4):356-356.e3. [Medline].

  8. Abraham HD. Visual phenomenology of the LSD flashback. Arch Gen Psychiatry. Aug 1983;40(8):884-9. [Medline].

  9. Abraham HD, Aldridge AM. Adverse consequences of lysergic acid diethylamide. Addiction. Oct 1993;88(10):1327-34. [Medline].

  10. Dyck E. Flashback: psychiatric experimentation with LSD in historical perspective. Can J Psychiatry. Jun 2005;50(7):381-8. [Medline].

  11. Freedman DX. The psychopharmacology of hallucinogenic agents. Annu Rev Med. 1969;20:409-18. [Medline].

  12. Johnston LD, O'Malley PM, Bachman JG. National survey results on drug use from the Monitoring the Future study, 1975-1993. Volume I: Secondary school students. Rockville, MD: National Institute on Drug Abuse; 1994.

  13. Klein M, Kramer F. Rave drugs: pharmacological considerations. AANA J. Feb 2004;72(1):61-7. [Medline].

  14. Klock JC, Boerner U, Becker CE. Coma, hyperthermia and bleeding associated with massive LSD overdose. A report of eight cases. West J Med. Mar 1974;120(3):183-8. [Medline].

  15. Kulig K. LSD. Emerg Med Clin North Am. Aug 1990;8(3):551-8. [Medline].

  16. Lerner AG, Gelkopf M, Oyffe I, et al. LSD-induced hallucinogen persisting perception disorder treatment with clonidine: an open pilot study. Int Clin Psychopharmacol. Jan 2000;15(1):35-7. [Medline].

  17. Lerner AG, Gelkopf M, Skladman I. Clonazepam treatment of lysergic acid diethylamide-induced hallucinogen persisting perception disorder with anxiety features. Int Clin Psychopharmacol. Mar 2003;18(2):101-5. [Medline].

  18. Lerner AG, Gelkopf M, Skladman I. Flashback and Hallucinogen Persisting Perception Disorder: clinical aspects and pharmacological treatment approach. Isr J Psychiatry Relat Sci. 2002;39(2):92-9. [Medline].

  19. McGlothlin WH, Arnold DO. LSD revisited. A ten-year follow-up of medical LSD use. Arch Gen Psychiatry. Jan 1971;24(1):35-49. [Medline].

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

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

  22. Parks KA, Kennedy CL. Club drugs: reasons for and consequences of use. J Psychoactive Drugs. Sep 2004;36(3):295-302. [Medline].

  23. Riedlinger TJ, Riedlinger JE. Psychedelic and entactogenic drugs in the treatment of depression. J Psychoactive Drugs. Jan-Mar 1994;26(1):41-55. [Medline].

  24. Schwartz RH. LSD. Its rise, fall, and renewed popularity among high school students. Pediatr Clin North Am. Apr 1995;42(2):403-13. [Medline].

  25. Schwartz RH, Comerci GD, Meeks JE. LSD: patterns of use by chemically dependent adolescents. J Pediatr. Dec 1987;111(6 Pt 1):936-8. [Medline].

  26. Shick JF, Smith DE. Analysis of the LSD flashback. J Psychedelic Drugs. 1970;3:13-19.

  27. Shoval G, Sever J, Sher L, Diller R, Apter A, Weizman A. Substance use, suicidality, and adolescent-onset schizophrenia: an Israeli 10-year retrospective study. J Child Adolesc Psychopharmacol. Dec 2006;16(6):767-75. [Medline].

  28. Sigafoos J, Green VA, Edrisinha C, Lancioni GE. Flashback to the 1960s: LSD in the treatment of autism. Dev Neurorehabil. Jan-Mar 2007;10(1):75-81. [Medline].

  29. Smart JK. History of chemical and biological warfare: An American perspective. In: Sidell FR, Takafuji ET, Franz DR, eds. Medical Aspects of Chemical and Biological Warfare. Washington, DC: Office of the Surgeon General; 1997:9-86.

  30. Smart RG, Bateman K. Unfavourable reactions to LSD: a review and analysis of the available case reports. Can Med Assoc J. Nov 11 1967;97(20):1214-21. [Medline].

  31. Strassman RJ. Hallucinogenic drugs in psychiatric research and treatment. Perspectives and prospects. J Nerv Ment Dis. Mar 1995;183(3):127-38. [Medline].

  32. Taylor RL, Maurer JI, Tinklenberg JR. Management of "bad trips" in an evolving drug scene. JAMA. Jul 20 1970;213(3):422-5. [Medline].

  33. Verduin ML, Payne RA, McRae AL, Back SE, Simpson SA, Sarang RY. Assessment of club drug use in a treatment-seeking sample of individuals with marijuana dependence. Am J Addict. Nov-Dec 2007;16(6):484-7. [Medline].

  34. Wynn GH, Cozza KL, Zapor MJ. Med-psych drug-drug interactions update. Antiretrovirals, part III: antiretrovirals and drugs of abuse. Psychosomatics. Jan-Feb 2005;46(1):79-87. [Medline].

 
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