Lysergic acid diethylamide toxicity: Difference between revisions

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Usually clinical and history, as patients presenting to the ED are brought in by concerned family member or friend who know of patient's recent drug usage.
Usually clinical and history, as patients presenting to the ED are brought in by concerned family member or friend who know of patient's recent drug usage.


LSD can be found in blood specimens at 6–12hr and in urine at 2–4days after usage.  The metabolite, 2-oxo-3-hydroxy-LSD, is present at higher concentrations than LSD in the urine and can be detected after LSD ingestion for a longer time than LSD itself.
LSD can be found in blood specimens at 6–12hr and in urine at 2–4days after usage.  The metabolite, 2-oxo-3-hydroxy-LSD, is present at higher concentrations than LSD in the urine and can be detected after LSD ingestion for a longer time than LSD itself.<ref>Passie, T. "The Pharmacology of Lysergic Acid Diethylamide: A Review". CNS Neuroscience & Therapeutics, Volume 14, Issue 4, pages 295–314, Winter 2008</ref>
 
However, most blood and urine testing mechanisms are restricted to laboratory studies and few are available for clinical usage.


==Management==
==Management==

Revision as of 19:56, 1 June 2015

Background

d-lysergic acid diethylamide, more commonly known as LSD, was first synthesized in 1938 by the chemist Albert Hofmann in efforts to chemically create a blood stimulant.[1]In 1943, Hoffman accidently ingested LSD for the first time, discovering its hallucinagenic properties, reportedly seeing "an uninterrupted stream of fantastic pictures, extraordinary shapes with intense, kaleidoscopelike play of colors."[2] LSD became very popular in the 1960's and 1970's, making it a very important part of the "counterculture" movement, encouraging participants to "turn on, tune in, drop out."[3]

Mechanism

Serotonin-like agents, like LSD, have similar chemical properties of serotonin. These are 5-HT2 agonists, mediating excitatory neurotransmitter release.[4] LSD also binds to dopaminergic receptors, contributing to its psychogenic affects.[5]

Pharmacology

Known as one of the most potent psychoactive drug, doses of minimum of 25μg. Doses of 1 to 1.5 μg/kg produce psychedelic effects, with the “optimum” dosage for a typical fully unfolded LSD reaction is estimated to be in the range of 100–200 μg.

Route of administration can be PO (most common), IM, or IV.[6] PO: Usual Dose 100-250μg, Onset 30-45mins, Peak effect 1-2.5hrs, Total duration 9-12hrs IM: Usual Dose 100-250μg, Onset 15-20mins, Peak effect 1hr, Total duration 9-10hrs IV: Usual Dose 40-180μg, Onset 3-5mins, Peak effect 1hr, Total duration 9-10hrs

Tolerance to LSD-25 builds up over consistent use and cross-tolerance has been demonstrated between LSD, mescaline and psilocybin.

Clinical Features

The acute ingestion of LSD is described as: "The initial effects begin 20-40 minutes with a sense of euphoria and dizziness...LSD is best described as a drug that strikes down barriers. The person who uses LSD is likely to feel detached from his/her ego, and can cross between states of consciousness. The user's perceptions are altered, causing visual and auditory hallucinations. One may notice that the walls of room are "breathing" or that motionless curtains appear to be moving. Senses appear to mix: a user might see music, taste colors, or hear visual stimuli. The LSD experience is often difficult to describe by users -- words lose meaning and are often insufficient in describing the effects of the drug; thoughts may seem unclear. Effects taper off after about 6-8 hours and are usually completely gone after a nights sleep."[7]

"Good Trips" are much like what is described as above, with seemingly normal or usual objects and experiences appearing new and changed to something breath-taking.

"Bad Trips" include experiences of paranoia, acute panic reactions, and agitation, usually stemming from the users prior mood to ingesting LSD. This, along with the user's altered perception of their environment, can lead to the user being subjected to dangers resulting in serious injury, disability, or death.

Differential Diagnosis

Serotonin-Like Agents

  • LSD
  • Psilocybin and psilocin dimethyltryptamine (DMT) and 5-methoxy- dimethyltryptamine (5-MeO-DMT)
  • Naturally occurring plants like :Hawaiian baby woodrose (Argyreia nervosa), Hawaiian woodrose (Merremia tuberosa), morning glory (Ipomoea violacea), and olili- uqui (Rivea corymbosa)

Enactogens

Dissociative Agents

Plant-based Hallucinogenics

  • Marijuana
  • Salvia
  • Absinthe
  • Isoxazole Mushrooms

Psychiatric Illnesses

Diagnosis

Usually clinical and history, as patients presenting to the ED are brought in by concerned family member or friend who know of patient's recent drug usage.

LSD can be found in blood specimens at 6–12hr and in urine at 2–4days after usage. The metabolite, 2-oxo-3-hydroxy-LSD, is present at higher concentrations than LSD in the urine and can be detected after LSD ingestion for a longer time than LSD itself.[8]

However, most blood and urine testing mechanisms are restricted to laboratory studies and few are available for clinical usage.

Management

Disposition

See Also

External Links

References

  1. Hofmann A. "Die Geschichte des LSD-25". Triangel Sandoz Zeitschrift fur Medizinische Wissenschaften. 1955;2(3):117-24. (as cited in Ott J. Pharmacotheon. 1993. pg 123.)
  2. http://www.theatlantic.com/health/archive/2014/09/the-accidental-discovery-of-lsd/379564/
  3. Leary, T. "Flashbacks." Tarcher, 1997.
  4. Ly, B. "Hallucinogens", Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th Ed. Pgs 2010-2012
  5. Marona-Lewicka D, Thisted RA, Nichols DE (2005). "Distinct temporal phases in the behavioral pharmacology of LSD: Dopamine D2 receptor-mediated effects in the rat and implications for psychosis". Psychopharmacology 180 (3): 427–435.
  6. Passie, T. "The Pharmacology of Lysergic Acid Diethylamide: A Review". CNS Neuroscience & Therapeutics, Volume 14, Issue 4, pages 295–314, Winter 2008
  7. https://www.erowid.org/chemicals/lsd/lsd_effects1.shtml
  8. Passie, T. "The Pharmacology of Lysergic Acid Diethylamide: A Review". CNS Neuroscience & Therapeutics, Volume 14, Issue 4, pages 295–314, Winter 2008