Lysergic Acid Diethylamide Toxicity - Symptoms, Diagnosis, and Treatment

Introduction

People have used various plants and fungi for thousands of years to induce the hallucinogenic effect. Hallucinogenic mushrooms were commonly used as natural substances. LSD is isolated from fungus in the lab.

What Is LSD?

D-lysergic acid diethylamide, or LSD, is a lysergamide group of compounds and can cause a psychedelic effect in humans when ingested. It was made by Albert Hofmann to be used as a central nervous system stimulant.

The Central Intelligence Agency used it as a tool for interrogation. It is an illegal drug that is colorless and tasteless. The drug is also called club drug.

The LSD is illegally sold under Adams, blotter, California triple dip, mellow yellow, sugar cube, and wedding bells.

How Is the Drug Consumed?

The drug is classified as a Schedule I drug in the US.

• The drug is taken orally in the form of a blotter.

• Small pills (microdot).

• Solution.

• Gelatin sheets (windowpane).

The drug is rapidly absorbed from the gastrointestinal tract.

What Is the Mechanism of Action of LSD?

LSD is a mind-altering drug that can work on the central nervous system and alter mood and behavior. LSD alters the serotonin action in the brain responsible for behavior, mood, senses, and thinking.

• The drug acts as a 5-HT2 receptor agonist, causing excitatory neurotransmitter release.

• The psychogenic effect is a result of the drug binding to dopaminergic receptors.

How Long Does the Drug Take to Show Effects?

• By Mouth - The symptoms start within 30 to 40 minutes, with the peak being around 1 to 2.5 hours. However, the effect can last for 12 hours.

• Through the Vein - The symptoms start within 3 to 5 minutes. The peak effect is seen within 1 hour, and the drug lasts 9 to 10 hours in the body.

• Intramuscular Route - The symptoms appear within 15 to 20 minutes.

Drug Dosage:

• A dose of 1 to 1.5 μg/kg (microgram per kilogram) causes a psychedelic effect.

• The optimum dosage for LSD reaction is 100-200μg.

Tolerance to LSD builds over consistent use, and cross-tolerance with psilocybin can also develop.

What Happens When LSD Is Used?

• A sense of euphoria develops.

• The sensation of colors and sounds is distorted.

• Dysphoria (state of dissatisfaction) changes with suffering are reported.

• Agitated behavior.

• In heavy doses, delirium, disorientation, and altered consciousness can occur.

• Lack of awareness of danger from surrounding, resulting in injury.

What Are LSD Trips?

The hallucinogenic drug causes the individual to experience unreal instances that may be formed at the back of the mind. A small dosage of drugs can induce a hallucinogenic effect and are termed “trips.” The trips can be good or bad depending on the dose. A good trip induces pleasure, and a bad trip can frighten the individual.

What Are the Signs and Symptoms of LSD?

Psychomimetic Symptoms:

• Panic reactions.

• Unconscious fear is amplified.

• Aggression on oneself.

• Tendency to inflict self-harm on others.

• Depression.

• Fear of insanity.

• Fear of rapid aging.

Somatic Symptoms:

• Loss of appetite.

• Nausea.

• Dry mouth.

• Drowsiness.

• Sleeplessness.

• Weakness.

• Paresthesia (pin and needle sensation in limbs).

• Tremors.

• Piloerection (Erection of skin hair).

• Seizures in rare cases.

Massive Doses of LSD Symptoms:

• Widely dilated pupils.

• Vomiting.

• Flushing.

• Sweating.

• Fever.

• Diarrhea.

• Transient hypertension.

• Hyperactivity with visual and auditory hallucinations.

• Sinus tachycardia.

• Hyperthermia.

• Respiratory arrest.

• Intracranial hemorrhage.

• Coagulopathies.

• Cardiac arrhythmias and Cardiovascular collapse.

• Coma.

• LSD toxicity, in association with other factors, can cause death.

How to Diagnose LSD Toxicity?

• Clinical history on the drug dosage, timing, place, and drug abuse history may be necessary.

• Physical examination for blood pressure, heart rate, and respiratory rate may be required.

• Individuals may need coagulation studies or serum electrolytes if seizures are present.

• Electro cardiomyography is required to monitor the cardiac condition.

• Quantifying LSD and its metabolite (2 -oxo -3 - hydroxy LSD) in serum and urine can help identify the drug in the individual.

• Radioimmunoassay can detect levels of 1.5-5.5 ng/ml within 24 hours of LSD intake.

• High-performance liquid or gas chromatography can be used as a confirmatory test after radioimmunoassay.

How to Treat LSD Toxicity?

The treatment provided is supportive.

• Caregivers must provide patients with a quiet environment.

• Patients must be stopped from self-harm or inflicting harm.

• Benzodiazepine to treat anxiety.

• Ativan and Haloperidol to treat agitation.

If huge amounts of LSD are taken:

• Antipsychotic drugs are necessary.

• LSD abusers may require respiratory support or endotracheal intubation if huge amounts of LSD are taken.

• LSD drug abusers may require symptomatic management of hypertension, tachycardia, hyperthermia, and hypotension.

• The patient may feel normal after the drug effect has worn off within 4 to 6 hours. The patient is discharged once they return to a straight baseline.

• Symptoms lasting longer than 8 to 12 hours require further monitoring.

• If the mental status is altered or psychosis is, further investigation is needed.

What Are the De-addiction Programs?

• Inpatient Treatment Program: Group therapy or counseling is provided. Family members are also counseled. The therapy may last for 30 to 90 days.

• Outpatient Treatment Program: The patient may attend treatment for 2 to 4 hours a day, two days a week, 4 to 8 hours per day, or 5 to 6 days per week. Patients continue with their normal social responsibilities.

Other Addiction Treatments:

• Cognitive behavior therapy replaces unacceptable behavior with positive ones and helps with the urge to use drugs.

• Motivational interviewing helps people to be more engaged in treatment and follow it.

• Contingency management is a treatment where patients are rewarded for being free from drugs.

What Is the Differential Diagnosis for LSD Toxicity?

• Psilocybin from toxic mushrooms. Psilocybin and LSD produce similar effects in individuals. However, Psilocybin is a whole-body experience compared to cerebral symptoms of LSD.

• Ethanol.

• MDMA.

• Psychosis.

• Schizophrenia.

What Are the Complications for LSD Toxicity?

• Persistent psychotic symptoms.

• Hallucinogen persisting perception disorder - Patients with a history of LSD use exhibit symptoms (flashbacks) that appeared on first LSD use when not intoxicated.

Criteria to Be Diagnosed for HPPD:

• Re-experiencing one or two perceptual symptoms experienced when abusers first used LSD.

• The symptoms tend to affect the individual's social or occupational life.

• The symptoms should not be associated with underlying health conditions or mental disorders.

Perceptual Symptoms:

• Geometric hallucinations.

• Intense or flashes of color.

• Halos around objects.

• Macropsia and micropsia.

• Positive afterimages.

Conclusion

LSD is an unpredictable drug, and it is difficult to identify when the patient may overdose. Developing tolerance to LSD and other hallucinogenic drugs. Frequent consumption can lead to patients taking more drugs to achieve pleasure. It is better to stay away from LSD or seek treatment immediately if they are drug abusers.