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|Methanol toxicity
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|Carbon Tetrachloride Toxicity
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|Lithium Toxicity
|NSAIDS Toxicity
|Ecstasy toxicity
|Paraquat toxicity
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|LSD Toxicity
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|Drug Toxicity with Specific Antidotes
💊 About LSD
- D-Lysergic acid diethylamide (LSD) is a potent semi-synthetic hallucinogen derived from ergot alkaloids of rye fungus.
- Usually taken orally as blotter paper (soaked squares), microdots (tablets), or liquid drops.
- Onset occurs within 30–60 minutes, with effects lasting 6–12 hours depending on dose, setting, and individual metabolism.
⚗️ Pharmacology
- LSD is a serotonergic hallucinogen, acting primarily as a partial agonist at the 5-HT2A receptor in cortical pyramidal neurons.
- It also affects dopaminergic and adrenergic receptors, leading to complex behavioural and autonomic changes.
- Extremely potent: active at 20–100 µg doses; no established lethal dose in humans.
- Metabolised hepatically and excreted mainly as 2-oxy-LSD (inactive).
🧠 Clinical Effects
- Autonomic: Tachycardia, hypertension, mydriasis, dry mouth, sweating, hyperthermia.
- Neurological: Visual distortions, synaesthesia (mixing of senses), altered sense of time and reality, impaired coordination.
- Psychiatric:
- Euphoria, spiritual insight, or heightened awareness.
- “Bad trip” - panic, agitation, paranoia, fear of death.
- Transient or persistent psychosis in predisposed individuals.
- Long-term risks: Hallucinogen Persisting Perception Disorder (HPPD) (visual flashbacks), anxiety, or depressive relapse.
🔬 Investigations
- LSD is rarely detected on standard toxicology screens due to its low dose and rapid metabolism.
- Specialised assays (e.g. GC-MS) can detect urinary 2-oxy-LSD for up to 24 hours.
- Routine work-up focuses on ruling out trauma, metabolic disturbances, or co-intoxication.
⚠️ Complications
- Accidental injury, falls, or self-harm during hallucination or disorientation.
- Persistent psychosis, especially with underlying schizophrenia or bipolar disorder.
- Seizures are rare - usually associated with co-ingestants (e.g. MDMA, amphetamines).
- Rhabdomyolysis and hyperthermia in severe agitation.
💊 Management
- Initial approach: ABCs, monitor vitals, ensure safety.
- Place in a quiet, low-stimulus environment with calm reassurance - most resolve with supportive care alone.
- Agitation or panic: Benzodiazepines (e.g. diazepam or lorazepam).
- Persistent psychosis: Short-term antipsychotic (e.g. haloperidol) may be used cautiously.
- Treat any co-ingestant effects (e.g. dehydration, hyperthermia, trauma).
🧩 Harm Reduction Notes
- LSD is not physiologically addictive but may cause psychological dependence.
- Avoid use in individuals with underlying psychiatric illness (e.g. schizophrenia, bipolar disorder).
- Potency varies widely among street preparations - risk of overdose and unpredictable reactions.
- “Set and setting” (user’s mindset and environment) profoundly influence experience and risk.
📚 References
🧠 Teaching tip:
LSD toxicity is rarely fatal - the danger lies in behavioural disinhibition and psychosis.
Always prioritise a calm setting, reassurance, and benzodiazepines over restraint. 🚑
