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ACUTE EXPOSURE INFORMATION

  1. USES: Lysergic acid diethylamide (LSD) is a hallucinogenic substance first synthesized in 1938. The d-isomer is the extremely potent hallucinogen while the l-isomer appears to be inactive. LSD was originally introduced as a drug for psychiatric use under the trade name of Delysid, but it has since been prohibited as a Schedule 1 substance in the United States. It is abused recreationally for its hallucinogenic effects. A closely related but less active compound, lysergic acid amide, is found naturally in the seeds of the morning glory and the Hawaiian baby wood rose. It is generally used orally, but it has also been used intravenously. There are also reports of patients who have snorted LSD.
  1. TOXICOLOGY: Although its mechanism of action is not exactly understood, it is known that LSD acts as a partial/full agonist at serotonin (5-HT) receptors.
  1. EPIDEMIOLOGY: LSD trafficking and abuse have decreased significantly since the year 2000; however, there are still hundreds of exposures reported every year to poison centers. Deaths and serious outcomes are usually due to trauma-related injuries rather than drug effects.
  1. WITH POISONING/EXPOSURE
    1. Ingestion of LSD causes alterations in cognition, resulting in auditory and visual hallucinations, behavioral changes, paranoia, mood fluctuations, and acute psychotic reactions. Within the first hour of ingestion, patients may experience feelings of tension, lightheadedness, mydriasis, twitching, flushing, tachycardia, hypertension and hyperreflexia. Perceptual changes may start after 30 minutes and include the aforementioned hallucinations and distortions of color, distance, shape, time, and synesthesias. Starting 2 to 12 hours from ingestion, the patient may experience euphoria, mood swings, feelings of depersonalization, derealization, and loss of body image. "Flashbacks" and panic reactions occur unpredictably and can occur even years after exposure. Injection of LSD causes similar symptoms. Seizures can develop in patients with severe toxicity. Rhabdomyolysis has also been reported.
    1. DRUG INTERACTIONS: Serotonin syndrome may develop if LSD is taken with other serotonergic drugs.
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