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Doses as small as The drug is odorless, colorless, and slightly bitter tasting. It is usually taken by mouth and is rapidly absorbed by the gastrointestinal GI tract. The image below depicts LSD in several different pill forms. While LSD usage reached epidemic proportions in the s, there has been a reduction of abuse owing to constraints on the manufacture and distribution of the drug.
It is classified as a Schedule I drug by the US Food and Drug Administration, meaning it is considered a narcotic drug with no known acceptable medical use that has a high potential for abuse, and the possession of any amount of LSD is illegal. There has also been Lsd overdose symptoms concerted effort to educate the public that the psychedelic experiences are a health hazard. Nevertheless, LSD continues to be used.
Pockets of continued abuse have been documented across the country. LSD toxicity can lead to respiratory arrest, coma, emesis, hyperthermia, autonomic instability, and bleeding disorders. In some cases, the patient's altered perceptions can result in behavioral toxicity, in which an individual fails to appreciate dangers in the environment and may be injured. Somatic symptoms of LSD toxicity, which are usually due to sympathomimetic effects, include the following:.
Massive overdoses can lead to the following [ 12 ] :. LSD has been found to be responsible for triggering serotonin syndrome in patients already using precipitating drug combinations serotonin precursors or agonists, serotonin-release stimulators, Lsd overdose symptoms serotonin reuptake inhibitors [SSRIs], nonselective serotonin-reuptake inhibitors, nonspecific inhibitors of 5-HT metabolism. In hallucinogen persisting perception disorder HPPDpatients who are not intoxicated experience symptoms flashbacks that initially arose during LSD use.
HPPD can last from months to years. Perceptual symptoms include the following [ 6 ] :.
See Clinical Presentation for more detail. Although LSD toxicity is diagnosed primarily by way of history and physical examination, LSD can be detected by radioimmunoassay. However, high-performance liquid chromatography or gas chromatography is required for confirmation. Diagnostic testing should be directed at identification Lsd overdose symptoms complications or exclusion of comorbidities.
Coagulation, total creatine phosphokinase, or serum electrolyte studies may be indicated in patients with seizures, coma, or a neuroleptic malignant syndrome—like presentation to identify coagulopathy or rhabdomyolysis or to exclude other diagnoses. The basic tenet of caring for patients who have ingested hallucinogens such as LSD is reassurance in a calm, stress-free environment that is safe for both patient and healthcare professionals.
Rarely, patients need to be either sedated or physically restrained. Benzodiazepines can Lsd overdose symptoms be given to treat agitation. Massive ingestions of LSD should be treated with supportive care, including respiratory support and endotracheal intubation if needed. The following should be treated symptomatically:. See Treatment and Medication for more detail.
The prototype of the hallucinogen class, LSD was first developed inwhen the Swiss biochemist Albert Hofmann synthesized it from lysergic acid while researching the medical effects of ergot-derived synthetic molecules. The American psychologist, writer, and futurist Timothy Leary Lsd overdose symptoms LSD and other hallucinogens in the s based on their alleged therapeutic and spiritual benefits.
This led to a psychedelic revolution, with large s of people using LSD as part of a counterculture movement. Because of the resulting public health concerns, however, restrictions were placed on LSD research and on its use in psychotherapy, and the drug was banned for recreational purposes by federal law in Other hallucinogens include mescaline, psilocybin, and ibogaine, which all possess a structural similarity to serotonin. See DDx. LSD causes changes in thought, mood, and perception, with minimal effects on memory and orientation.
The drug primarily produces so-called pseudohallucinations, which are illusions derived from the misinterpretation of actual experiences. These include synesthesias, in which the transposition of certain sensory modes occurs, creating an experience known as sensory crossover. For example, the perception of a sound evoked by a visual image or the impression of hearing colors or feeling sounds would be considered a synesthesia. True hallucinations occur as well; visual hallucinations are the most common. Users are typically aware that visual, auditory, and olfactorial perceptions are distorted and unreal; however, acute adverse drug effects can include panic reactions, psychoses, and major depression.
One case report describes a young man under the influence of LSD and alcohol who amputated his testicles. LSD can be synthesized from easily obtainable chemicals or from naturally occurring substances. Ergotamine alkaloids produced from a fungus that grows on rye and other grains contain lysergic acid. LSD is produced as a crystalline powder and then mixed with various binding agents. Although LSD possesses Lsd overdose symptoms wide margin of safety, single doses obtained over recent years were ificantly less potent than those available during the s and s, when a dose contained mcg or more of LSD.
Primary motivations given for the use of LSD are experimentation, a desire to feel good, and a perceived enhancement of social interactions. It Lsd overdose symptoms also inexpensive. See Epidemiology. With this method, the LDS is sprayed onto the small squares of decorative paper, creating the product known as blotter acid.
The blotter paper is often imprinted with fanciful des or cartoons ie, trademarks for the manufacturer. The drug is sold under more than 80 street names, including "A", acid, Adams, back breaker, battery acid, beast, blotter, blue chairs, blue cheers, blue mist, brown dot, buttons, California triple dip, cube, dose, dot, Elvis, flat blues, gelatin, green wedge, hawk, looney toons, Lucy in the sky with diamonds, M and Ms, mellow yellow, mescal, microdot, mighty Quinn, mind detergent, Owsley acid, Owsley blue dot, pane, pearly gates, pink wedge, pink Owsley, purple Owsley, Sandoz's, strawberries, sugar cube, sunshine, Superman, uncle, vacation, wedding bells, window pane, and Zen.
Dermal absorption has not been well documented. LSD can be aerosolized and is absorbed by the lungs if the particle diameter is 5 micrometers or less. Because of their structural similarity to serotonin and their intrinsic potency, hallucinogens disrupt the balanced functioning of the serotonin system. Hallucinogens have a high affinity for serotonin 5-HT receptors, at which LSD exhibits agonist and antagonist properties. The 5-HT 2A receptor plays a major role in the modulation of sensory als and is predominantly found in pyramidal neurons of the prefrontal cerebral cortex, where hallucinogens have effects on cognition, mood, perception, and emotions ranging from fear to euphoria.
These receptors are also thought to be responsible for the pathology and therapy of schizophrenia. Serotonin receptors found in the locus coeruleus are important for sensory modulation and are responsible for the sympathomimetic effects of the drug hypertension, tachycardia, dizziness, loss of appetite, dry mouth, sweating, nausea, numbness, tremor. Affinities to other serotonin receptors differ between the 2 hallucinogen classes, which makes attributing specific effects to a single 5-HT receptor subtype impossible.
LSD also stimulates dopamine D2 receptors. The relationship between the dopaminergic and serotonergic systems is not fully understood. After oral administration, the early drug effects of LSD appear after minutes. More profound psychoactive effects peak at hours and some effects may last as long as 12 hours. LSD is rapidly metabolized in the liver by N-demethylation, N-deethylation, and aromatic hydroxylation after oral ingestion. The elimination half-life of LSD is hours. Although LSD does not cause physical or psychological addiction, users quickly develop a high degree of short-lived tolerance tachyphylaxiswhich is due to down-regulation of 5-HT 2A receptors.
The overall prevalence of LSD use among adolescents and young adults ages 15 Lsd overdose symptoms 34 years in Europe is estimated to be under 1. While LSD is included in national drug trending reports, the accuracy of these for actual LSD use is complicated by novel Lsd overdose symptoms hallucinogenic compounds being marketed as LSD. For example, a new class of deer research chemicals includes highly potent hallucinogenic serotonin agonists. The drug is taken via the buccal or sublingual route, just like LSD.
A survey of adults aged 18—25 years in entering electronic dance music EDM events at nightclubs and festivals in New York City found 2. Males use LSD more frequently than do females. The typical LSD user is a risk-taking, white male in high school or college.
Sincethere has been a considerable falloff in reported availability among middle- and high-school students, which is reflected in the ificant decline in use among younger adolescents. The long-term prognosis for persons who use LSD is Lsd overdose symptoms provided that they stop using it, and most users voluntarily decrease or stop the use of the drug over time. LSD is not considered an addictive drug, because it does not produce compulsive drug-seeking behavior; however, LSD does produce a physiologic tolerance, requiring subsequent increased doses to achieve the same effect.
For those who use LSD chronically, there is the enhanced risk for schizophreniform psychosis and derangements in memory function, problem solving, and abstract thinking. LSD potentially may exacerbate comorbid conditions in elderly patients. The lethal dose of LSD has been estimated to be 14, mcg. However, only a few cases of massive ingestions have been reported. For example, eight individuals who believed they had Lsd overdose symptoms accidentally insufflated an extremely high dose of LSD. These individuals all became comatose, with hyperthermia, vomiting, light gastric bleeding, and respiratory problems.
With hospital treatment, however, all were reported to have survived without apparent residual effects.
The patient's altered perceptions can lead to behavioral toxicity, in which the patient does not appreciate the dangers in the environment and may be injured. Users may believe that they are invincible or Lsd overdose symptoms superpowers and may do things they would not normally consider, such as believing they can fly, jumping from buildings, or incurring severe ocular damage by prolonged staring at the sun.
Despite early reports of LSD-related fetal malformations, inadequate evidence exists to establish causality. Hallucinogen persisting perception Lsd overdose symptoms HPPD has an estimated prevalence of 4. Flashbacks tend to occur during times of psychological stress and can last for minutes to hours. HPPD may last several months; however, some patients report these experiences for as long as 5 years, with many of these individuals having an underlying psychiatric illness. Counsel patients on the potential dangers of LSD use, including driving automobiles while intoxicated or combining LSD ingestion with ethanol, marijuana, or other illicit drugs.
Because the metabolism of LSD is not fully understood, HIV-positive patients on highly active antiretroviral therapy should be counseled to not use LSD, due to the possibility of adverse drug-drug interactions. For patient education information, see Substance Abuse. Olson KR, ed. Chapter O'Brien CP. Drug Addiction. Cocaine and Other Commonly Abused Drugs. Harrison's Principles of Internal Medicine. Martin TG. Serotonin syndrome. Ann Emerg Med.
American Psychiatric Association.
Substance Related Disorders. Sanders-Bush E, Hazelwood L. The pharmacology of lysergic acid diethylamide: a review. CNS Neurosci Ther. Vollenweider FX, Kometer M. The neurobiology of psychedelic drugs: implications for the treatment of mood disorders. Nat Rev Neurosci. Fusar-Poli P, Borgwardt S. Albert Hofmann, the father of LSD Epub Sep National Institute on Drug Abuse. February ; Accessed: June 11, Self-inflicted testicular amputation in first lysergic acid diethylamide use.Lsd overdose symptoms
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LSD Overdoses: Three Case Reports