LSD AND OTHER

HALLUCINOGEN
C L I N I C A L C H E M I S T RY 2
WHAT IS LSD
• The full chemical name of LSD is d-lysergic
acid diethylamide.
• LSD is classified as a hallucinogenic
chemical (Hallucinogen) that is derived
from a parasitic fungus that grows on rye.
• LSD is produced as a crystal, then dissolved
in alcohol prior to sale and consumption.
• LSD users describe their experience with
the drug as a “trip”.
WHAT’S A ”TRIP”?
• Trip – user starts seeing hallucinations
o 12-14 hours after use
o Experience is unpredictable
• What can one trip be like?
o One may have an amazing experience
o Whereas some may be left mentally
scarred for the rest of their life
o Some may have panic attacks and/or
intense anxiety
MECHANISM OF TOXICITY
• LSD binds to most serotonin receptor subtypes except fot 5-HT3 and 5-
HT4
• The psychedelic effects of LSD are attributed to its strong partial agonist
effects at 5-HT2A receptor.
• Many other agents are thought to alter the activity of serotonin and
dopamine in the brain
• Central and peripheral sympathetic stimulation may account for some
side effects
Anxiety
Psychosis
Dilated pupil
MECHANISM OF TOXICOLOGY
TOXIC DOSE
• Depening on the agent and the circumstances
• In general, entactogenic effects do not appear to be dose related
• Increasing the dose does not intensity the disired effects
• Paranoid or panic attacks may occur with any dose and depend
on the surrounding and the patient’s current emotion state.
• Hallucinations , visual illusions , and sympathomimetic
side effects are dose-related
• The toxic dose may be only slightly greater than the therapeutic
dose.
 EXAMPLES OF HALLUCINOGENS
Drugs or Compound Common Name Comments
5-Hydroxy-N,N-dimethlytryptamine Bufotenine From skin secretions of the toad Bufo vulgaris
N,N-dimethlytryptamine DMT “Businessman’s trip” short dulation (30-60 mins)
2,5-Dimethoxy-4-bromo-amphetamine DOB Potent ergotlike vascular spasm may result in ischemia, gangrene.

2,5-Dimethoxy-4-methly-amphetamine DOM,STP Potent sympathomimetic.

4,9-Dihydro-7-methoxy-1-methyl-3-pyrido(3,4)-indole Harmaline South American religious and cultural drink called yage or ayahuasca.

Lygeric acid diethylamide LSD,acid Potent hallucinogen.Average dose 50-150 ug in tablets , papers.

N-Methyl-1-(1,3-benzodioxol-5-yl)-2-butanamine MBDB Nearly pure entactogen without hallucinosis or sympathomimetic

stimulation.
3,4-Methylenedioxy-amphetamine MDA Potent sympathomimetic. Several hyperthermic dealths reported.

3,4-Methylenedioxy-methaamphetamine MDMA,ecstasy,Adam Sympathomimetic; hyperthermia reported.

3,4-Methylenedioxy-n-ethylamphetamine MDE,Eve
3,4,5-Trimethoxyphenethylamine Mescaline Derived from peyote cactus
3-Methoxylenedioxy-4,5-methylene-dioxyallylbenzene Myristicin,nutmeg

p-Methoxyamphetamine PMA
4-Phosphoryloxy-N-N-dimethyltryptamine Psilocybin From Psilocybe mushrooms.
CLINICAL PRESENTATION
A. Mild to Moderate intoxication
• The person experiencing a “bad trip”

Conscious
Coherent
Oriented
Anxious
Fearful
Paranoid
Bizarre reasoning
CLINICAL PRESENTATION

Tearful
Combative
Self-destruction
Delayed intermittent
“flashback”
CLINICAL PRESENTATION
• The person with dose-related
sympathomimetic side effects may also
 Exhibit tachycardia
 Mydriasis (dilated pupils)
 Diaphoresis
Bruxism
Short attention span
Tremor
Hyperreflexia
Hypertention
Fever
CLINICAL PRESENTATION
U N T R E AT E D
H Y P E RT H E M I A
• B. Life-threatening toxicity
 Hypotension
• Results from intense
 Coagulopathy
sympathomimetic stimulation and
 Rhabdomyolysis
includes
 Multiple organ failure
Seizures
Severe hyperthermia
Hypertension
Cardiac arrhythmias
CLINICAL PRESENTATION

• Hyperthermic patients are usually

Obtunded
Agitate or thrashing about
Diaphoretic
hyperreflexic

Hyperthermia has been associated with

LSD, methyl-D-aspartate (MDA), and
phenylmercapturic acid (PMA).
CLINICAL PRESENTATION
• Use of 2,5-dimethoxy-4-bromoamphetamine (DOB)
Ergot like vascular spasm
Circulatory insuffiency
gangrene
EFFECTS OF LSD
DIAGNOSIS
• Based on
A history of use
The presence of signs of sympathetic stimulation
• A. Specific levels
• The amphetamine derivatives (DOB , STP ,MDA, MDMA,
etc) cross-react in many of the available screening
procedures for amphetamine class drugs.
• LSD and the other nonamphetamine hallucinogens are not
identified on routine intoxicity screening
DIAGNOSIS
• B.Other useful laboratory studies
Electrolyte
Glucose
BUN
Creatinine
• In hyperthermic patients
Obtain prothrombin time
CPK
Urinalysis dipstick for occult blood (myoglobinuria will be positive)
 TREATMENT
• A. For the patient with a bad trip
or panic reaction
Relaxion technique in a quite
environment
• Agitation or severe anxiety state
Diazepam or midazolam
TREATMENT
• B. Specific drugs and antidotes
• There is no specific antidote
• Sedating doses of Dizepam (2-10 mg) may
alleviate anxiety
• Hypnotic doses (10-20 mg) – can induce
sleep for the duration of the “trip” (usually
4-10 hours)
TREATMENT
• C. Decontamination
• 1. Prehospital
• Activated charcoal –do not vomiting,
because it is relatively ineffective and to
aggravate psychologic distress.

• Emesis – after a recent massive ingestion if

there is no charcoal available and hospital
transport will take more than 30 mins
TREATMENT

• 2. Hospital
Administer activated charcoal
No need for gastric lavage
Unless massive ingestion is suspected
or the person is unable to ingest
charcoal
• THANK YOU