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For further information, see CMDT Part 40-41: LSD & Other Hallucinogens Overdose

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

  • Plants and mushrooms containing hallucinogenic indoles (eg, mescaline, psilocybin, LSD) may cause

    • Marked visual hallucinations and perceptual distortion

    • Widely dilated pupils

    • Mild tachycardia

  • Phencyclidine (PCP) and ketamine can produce a dissociative state often associated with vertical and horizontal nystagmus

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

    • 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 cathinone derivatives

TREATMENT

  • Emergency and supportive measures

    • Maintain a patent airway and assist breathing if necessary

    • Treat coma, hyperthermia, hypertension, and seizures

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

  • 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 more effective than lidocaine or amiodarone

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