Posted: July 4th, 2024

Acute Lysergic Acid Diethylamide (LSD) Toxicity: Clinical Presentation and Management

Acute Lysergic Acid Diethylamide (LSD) Toxicity: Clinical Presentation and Management

LSD intoxication presents a complex clinical picture that requires prompt recognition and appropriate management in the emergency setting. This paper examines the typical signs of acute LSD toxicity, diagnostic approaches, initial treatment strategies, and characteristic laboratory findings associated with this condition.

Signs of Acute LSD Toxicity

Acute LSD toxicity manifests through a range of physiological and psychological symptoms. Patients commonly exhibit tachycardia, hypertension, hyperthermia, and dilated pupils (Liechti, 2017). Neurological effects include tremors, ataxia, and hyperreflexia. Psychological disturbances are prominent, with patients experiencing visual and auditory hallucinations, altered perception of time and space, and mood lability. Severe cases may present with acute psychosis, panic attacks, or profound agitation (Schmid et al., 2021).

Diagnosis and Initial Therapy

Diagnosis of LSD intoxication relies primarily on clinical presentation and history, as routine toxicology screens do not detect LSD. Specialized testing, such as high-performance liquid chromatography or mass spectrometry, can confirm LSD exposure but is not typically available in the acute setting (Dolder et al., 2018). Initial management focuses on supportive care and symptom control. Patients should be placed in a calm, low-stimulation environment. Benzodiazepines are often administered to manage agitation and anxiety. Vital signs and hydration status require close monitoring, with fluid resuscitation provided as needed (Carbonaro and Gable, 2019).

Characteristic Laboratory Findings

While specific laboratory tests for LSD are not routinely available, certain findings may support the diagnosis. Mild leukocytosis and elevated creatine kinase levels are occasionally observed. Electrolyte imbalances, particularly hyponatremia, may occur due to excessive water consumption. Liver function tests and renal parameters are typically normal but should be assessed to rule out complications. Blood glucose levels may be elevated due to the sympathomimetic effects of LSD (Dolder et al., 2018).

The management of acute LSD toxicity requires a comprehensive approach that addresses both the physiological and psychological aspects of intoxication. Healthcare providers must remain vigilant for potential complications and provide appropriate supportive care to ensure optimal patient outcomes.

References

Carbonaro, T.M. and Gable, R.S., 2019. LSD administration to humans: A harm reduction approach. In The Therapeutic Use of Ayahuasca (pp. 185-204). Springer, Cham.

Dolder, P.C., Liechti, M.E. and Rentsch, K.M., 2018. Development and validation of an LC-MS/MS method to quantify lysergic acid diethylamide (LSD), iso-LSD, 2-oxo-3-hydroxy-LSD, and nor-LSD and identify novel metabolites in plasma samples in a controlled clinical trial. Journal of Clinical Psychopharmacology, 38(3), pp.239-247.

Liechti, M.E., 2017. Modern clinical research on LSD. Neuropsychopharmacology, 42(11), pp.2114-2127.

Schmid, Y., Müller, F., Borgwardt, S. and Liechti, M.E., 2021. Use of hallucinogens: Epidemiology, pharmacology, and psychobiology of acute and long-term effects. Dialogues in Clinical Neuroscience, 23(1), pp.47-58.

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History: An 18-year-old male presents to your emergency department after
ingesting an unknown quantity of lysergic acid diethylamide (LSD). His
friends brought him in because he was “acting goofy.” He is not currently
suicidal and has no plan to hurt himself. He claims not to have taken any
other substances.
PMH: None.
SH: No previous suicide attempts and no history of depression.

Physical Examination:
T: 100.4°F HR: 124 bpm RR: 18 breaths per minute BP: 150/90 mm Hg
General: Agitated and actively hallucinating. The skin is moist and pale.
HEENT: Pupils are 4 mm bilaterally with sluggish light reaction. No nystagmus.
Pulmonary: Clear to auscultation.
CV: Regular rate and rhythm without murmur.
Abdomen: Soft and nontender with hyperactive bowel sounds.
Neurologic: GCS 14. Cranial nerves II-XII intact. Fine tremor.
QUESTIONS CASE STUDY #8
1. What are the usual signs of acute toxicity?
2. How is the diagnosis confirmed and which initial therapy should be instituted?
3. What are the characteristic laboratory findings?

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Tags: Acute Lysergic Acid Diethylamide (LSD) Toxicity: Clinical Presentation and Management, An 18-year-old male presents to your emergency department after ingesting an unknown quantity of lysergic acid diethylamide (LSD)