25. HALLUCINOGENS – LSD

Lysergic acid diethylamide (LSD) is a potent hallucinogenic drug derived from ergot alkaloids. It produces profound alterations in perception, mood, and cognition. Although LSD toxicity is rarely fatal, psychological distress, dangerous behavior, and sympathetic overactivity may require medical intervention. Understanding its effects and management is essential in clinical toxicology.

Mechanism of Action

  • Acts primarily as a 5-HT2A serotonin receptor agonist
  • Modulates dopamine and adrenergic pathways
  • Alters cortical processing, leading to hallucinations and sensory distortion

Clinical Effects of LSD

Psychological Effects

  • Visual hallucinations
  • Altered perception of time and space
  • Euphoria or spiritual experiences
  • Anxiety or panic attacks

Physiological Effects

  • Mydriasis
  • Tachycardia
  • Hypertension
  • Hyperthermia
  • Sweating and tremors

Adverse Reactions (“Bad Trips”)

  • Severe agitation or panic
  • Paranoia and confusion
  • Fear of losing control
  • Self-harm or violent behavior during hallucinations

Complications

  • Accidents or trauma due to impaired judgment
  • Severe hyperthermia
  • Serotonin syndrome (rare; higher risk with SSRIs, MDMA)
  • Flashbacks or Hallucinogen Persisting Perception Disorder (HPPD)

Diagnosis

  • Clinical evaluation based on psychotropic symptoms
  • No routinely available rapid lab test for LSD
  • Rule out other causes of psychosis or intoxication

Management

1. Supportive Care (Mainstay of Treatment)

  • Calm, low-stimulation environment
  • Verbal reassurance (“talking down”)

2. Sedation

  • Benzodiazepines for severe agitation or panic
  • Avoid antipsychotics unless needed (risk of worsening symptoms)

3. Hyperthermia Management

  • Cooling blankets and IV fluids

4. Treat Complications

  • Manage serotonin syndrome as per standard protocol
  • Address trauma or injuries

5. Psychiatric Support

  • Counseling for recurring hallucinations
  • Long-term follow-up for HPPD

Prognosis

LSD toxicity usually resolves within 8–12 hours with supportive care. Serious long-term medical complications are rare, though psychological effects may persist in vulnerable individuals.

Detailed Notes:

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PATH: PHARMD/ PHARMD NOTES/ PHARMD FOURTH YEAR NOTES/ CLINICAL TOXICOLOGY/ HALLUCINOGENS – LSD.

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