Psilocybin toxicity: Difference between revisions
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==Background == | ==Background== | ||
*A compound found in over 200 mushrooms that has mind altering properties similar to LSD. | |||
*Commonly known as "magic mushrooms" or "shrooms". The mushroom are often taken recreationally for the euphoric and hallucinogenic effects. Typically grown in the Pacific Northwest and southern regions of the United States. | |||
*For a typical dose (1mg) symptoms will last 1-3 hours. | |||
*Low toxicity with LD50 of 280mg/kg | |||
**Therapeutic index = 641 | |||
[[File:Psilocybe semilanceata.jpg|thumb|''Psilocybe semilanceata'']] | [[File:Psilocybe semilanceata.jpg|thumb|''Psilocybe semilanceata'']] | ||
==Clinical Features== | |||
== Clinical Features== | |||
*Sensory/psychiatric | *Sensory/psychiatric | ||
**Euphoria | **Euphoria | ||
| Line 24: | Line 24: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* [[Hypoglycemia]] | *[[Hypoglycemia]] | ||
* [[TBI]] | *[[TBI]] | ||
* [[CO poisoning]] | *[[CO poisoning]] | ||
* [[Meningitis]]/[[Encephalitis]] | *[[Meningitis]]/[[Encephalitis]] | ||
* [[Opioid intoxication]] | *[[Opioid intoxication]] | ||
* [[Antihistamines]]/[[Anticholinergic toxicity]] | *[[Antihistamines]]/[[Anticholinergic toxicity]] | ||
{{Drugs of abuse types}} | {{Drugs of abuse types}} | ||
{{Hallucinogen types}} | |||
==Evaluation== | ==Evaluation== | ||
| Line 37: | Line 38: | ||
*[[Urine drug screen]] if concerned about co-ingestion | *[[Urine drug screen]] if concerned about co-ingestion | ||
== Management == | ==Management== | ||
*Supportive care | *Supportive care | ||
*Place patient in a calm and quiet environment | *Place patient in a calm and quiet environment | ||
| Line 49: | Line 50: | ||
*[[Drugs of abuse]] | *[[Drugs of abuse]] | ||
== References == | ==References== | ||
<references/> | |||
[[Category:Toxicology]] | |||
Latest revision as of 20:34, 12 January 2021
Background
- A compound found in over 200 mushrooms that has mind altering properties similar to LSD.
- Commonly known as "magic mushrooms" or "shrooms". The mushroom are often taken recreationally for the euphoric and hallucinogenic effects. Typically grown in the Pacific Northwest and southern regions of the United States.
- For a typical dose (1mg) symptoms will last 1-3 hours.
- Low toxicity with LD50 of 280mg/kg
- Therapeutic index = 641
Clinical Features
- Sensory/psychiatric
- Euphoria
- Visual hallucinations, synesthesia
- Lethargy, Depression
- Anxiety, agitation
- Confusion, disorientation
- Above may lead to accidental trauma
- Sympathetic effects
- Mydriasis
- Tachycardia
- Hypertension
- Nausea
- Hypotension
Differential Diagnosis
- Hypoglycemia
- TBI
- CO poisoning
- Meningitis/Encephalitis
- Opioid intoxication
- Antihistamines/Anticholinergic toxicity
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
Hallucinations
Serotonin-Like Agents
- Lysergic acid diethylamide (LSD)
- Psilocybin ("magic mushrooms")
- N,N-Dimethyltryptamine (DMT)
- 5-methoxy- dimethyltryptamine (5-MeO-DMT)
- 25C-NBOMe
Enactogens
- Designer amphetamines
- Bath salts
- Ecstasy (MDMA)
- Mescaline (peyote)
- Synthetic cannabinoids
Dissociative Agents
- Phencyclidine (PCP)
- Ketamine
- Dextromethorphan
- Nitrous oxide
Plant-based Hallucinogenics
- Marijuana
- Salvia
- Absinthe
- Isoxazole Mushrooms
- Hawaiian baby woodrose (Argyreia nervosa)
- Hawaiian woodrose (Merremia tuberosa)
- Morning glory (Ipomoea violacea)
- Olili- uqui (Rivea corymbosa)
Organic causes
- Delirium
- Intracranial mass to occipital or temporal lobes
- Encephalitis, limbic encephalitis, anti-NMDA receptor encephalitis
- Migraine
- Seizure
- Hypocalcemia/Hypercalcemia
- Rift valley fever
- Rabies
- Syphilis
- Vitamin B7 deficiency
- Pellagra
- Dementia
Other Toxicologic Causes
- Alcohol withdrawal
- Anticholinergic Toxicity
- Tricyclic (TCA) Toxicity
- Synthetic cannabinoids
- Inhalant abuse
- Nitrogen narcosis
- GHB withdrawal
- Hydrocarbon toxicity
- Heavy metal toxicity
- Multiple medications: montelukast, doxapram, hyoscyamine, tizanidine, peramivir, amantadine, rimantadine, bromocriptine, methylergonovine, benztropine, doxepin, voriconazole, acyclovir, valacyclovir, ganciclovir, cimetidine, penicillin G Procaine, clarithromycin, metoclopramide
- Inhalant abuse
Psychiatric Causes [1]
- Schizophrenia, schizoaffective disorder, schizophreniform disorder
- Depression with psychotic features
- Bipolar disorder
- Charles Bonnet Syndrome (in the visually impaired)
Evaluation
- Clinical diagnosis
- Urine drug screen if concerned about co-ingestion
Management
- Supportive care
- Place patient in a calm and quiet environment
- Benzodiazepines for worsening tachycardia/hypertension or agitation
Disposition
- Discharge when vitals normalize and clinically sober
See Also
References
- ↑ Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156