LSD & Hallucinogens

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

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

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