LSD Poisoning Follow-up

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

Further Inpatient Care

  • Admission is warranted in the setting of serious comorbidity or if the patient is severely intoxicated, requires prolonged observation, or is suicidal.
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Further Outpatient Care

  • Most patients are discharged after a period of observation. Discharge patients into the care of a responsible adult. Carefully explain discharge instructions to the patient and accompanying friends or family members. In appropriate cases, refer patients for outpatient drug counseling.
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Inpatient & Outpatient Medications

  • Admitted patients may warrant continued administration of anxiolytics or other medications directed at specific symptoms. Outpatient medications rarely are necessary.
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Transfer

  • As most patients only require a period of observation, transfer rarely is necessary. However, transfer may be justified in situations of serious complications or comorbidity or when management of behavioral symptoms exceeds the capability of the facility.
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Deterrence/Prevention

  • The only feasible deterrence is abstinence.
  • "Mind Over Matter," an educational tool designed to encourage young people in grades 5-9 to learn about the effects of drug abuse on the body and brain (see National Institute on Drug Abuse, Mind Over Matter).
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Complications

  • Complications include persistent or recurrent affective disorders (eg, depression), although these are usually reversible.
  • LSD exacerbates preexisting psychiatric illness (eg, psychosis).
  • The drug disrupts personality.
  • Flashbacks and HPPD are reported in 15-77% of LSD users. Flashbacks and HPPD represent a continuum of severity of signs and symptoms, with flashbacks being the more short-term phenomenon. Flashbacks last minutes to hours and tend to occur during times of psychological stress. With cessation of LSD use, flashbacks tend to stop with time. However, in one study by Abraham, 50% of subjects experienced flashbacks 5 or more years after they stopped using LSD.[8] Flashbacks are characterized by visual disturbances including the following:
    • Geometric hallucinations
    • Flashes of color
    • Moving light
    • Terrifying illusions of people decomposing, crawling bugs or skulls, Satan's face superimposed on the faces of friends, or objects melting
    • Impaired color perception
  • HPPD is a more long-term condition that may or may not resolve with time.
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Prognosis

  • The long-term prognosis for LSD users is good, provided they stop using the drug.
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Patient Education

  • Counsel patients on the potential dangers of LSD use, including driving automobiles while intoxicated or combining LSD ingestion with ethanol, marijuana, or other illicit drugs.
  • Because the metabolism of LSD is not fully understood, HIV-positive patients on highly active antiretroviral therapy should be counseled to not use LSD due to the possibility of adverse drug-drug interactions.
  • For excellent patient education resources, visit eMedicine's Bioterrorism and Warfare Center. Also, see eMedicine's patient education article Chemical Warfare.
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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.

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