LSD & Hallucinogens

Key Features

• The mechanism of toxicity and the clinical effects vary for each substance

Clinical Findings

• Anticholinergic delirium

  • Dilated pupils

  • Flushed skin

  • Dry mucous membranes

  • Tachycardia

  • Urinary retention

• LSD

  • Marked visual hallucinations and perceptual distortion

  • Widely dilated pupils

  • Mild tachycardia

• Phencyclidine (PCP) can produce fluctuating delirium and coma, often with vertical and horizontal nystagmus

• Toluene and other hydrocarbon solvents (eg, butane, trichloroethylene)

  • Euphoria

  • Delirium

  • Potentially fatal dysrhythmias

• Other drugs used for their psychostimulant effects include

  • Synthetic cannabinoid receptor agonists

  • Salvia divinorum

  • Synthetic tryptamines and phenylethylamines

  • Mephedrone and related cathionone derivatives

Treatment

• For recent ingestions, administer activated charcoal, 60–100 g orally or via gastric tube, mixed in aqueous slurry

• Treat anticholinergic delirium with physostigmine salicylate, 0.5–1.0 mg intravenously, not to exceed 1 mg/min

• Caution: Bradyarrhythmias and convulsions can occur with physostigmine use

• Treat dysphoria, agitation, or psychosis from LSD or mescaline intoxication with

  • Lorazepam, 1–2 mg orally or intravenously

  • Haloperidol, 2–5 mg intramuscularly or intravenously

  • Another antipsychotic drug (eg, olanzapine or ziprasidone)

• Monitor patients who have sniffed solvents for cardiac dysrhythmias; beta-blockers (eg, propranolol, 1–5 mg intravenously, or esmolol, 250–500 mcg/kg intravenously, then 50 mcg/kg/min by infusion) may be used