Ver el código de «Lysergic acid diethylamide toxicity»

==Background==
*Also known as d-lysergic acid diethylamide and LSD

===Mechanism===
*Similar to chemical properties of serotonin
**5-HT2 agonists, mediating excitatory neurotransmitter release.<ref>Ly, B. "Hallucinogens", ''Rosen's Emergency Medicine: Concepts and Clinical Practice''. 7th Ed. Pgs 2010-2012</ref>  
*LSD also binds to dopaminergic receptors, contributing to its psychogenic affects.<ref>Marona-Lewicka D, Thisted RA, Nichols DE (2005). "Distinct temporal phases in the behavioral pharmacology of LSD: Dopamine D2 receptor-mediated effects in the rat and implications for psychosis". Psychopharmacology 180 (3): 427–435.</ref>

===Pharmacology===
*Known as one of the most potent psychoactive drug, doses of minimum of 25μg. Doses of 1 to 1.5 μg/kg produce psychedelic effects, with the “optimum” dosage for a typical fully unfolded LSD reaction is estimated to be in the range of 100–200 μg.<br />
*Route of administration can be PO (most common), IM, or IV.<ref>Passie, T. "The Pharmacology of Lysergic Acid Diethylamide: A Review". CNS Neuroscience & Therapeutics, Volume 14, Issue 4,  pages 295–314, Winter 2008</ref>
**PO: Usual Dose 100-250μg, Onset 30-45mins, Peak effect 1-2.5hrs, Total duration 9-12hrs
**IM: Usual Dose 100-250μg, Onset 15-20mins, Peak effect 1hr, Total duration 9-10hrs
**IV: Usual Dose 40-180μg, Onset 3-5mins, Peak effect 1hr, Total duration 9-10hrs<br />
*Tolerance to LSD-25 builds up over consistent use and cross-tolerance has been demonstrated between LSD, [[mescaline]] and [[psilocybin]].<ref>Passie, T. "The Pharmacology of Lysergic Acid Diethylamide: A Review". CNS Neuroscience & Therapeutics, Volume 14, Issue 4, pages 295–314, Winter 2008</ref>

==Clinical Features==
*Effects begin around 20-40 minutes after injection
*Euphoria 
*Dizziness
*Visual and auditory [[hallucinations]]
*Synesthesia ("seeing sounds" and "hearing colors")
*Paranoia
*Acute panic reactions / [[agitation]]
*Effects taper off after about 6-8 hours, depending on dose

==Differential Diagnosis==
{{Hallucinogen types}}

==Evaluation==
*Usually clinical, based on history and presentation
''Most blood and urine tests are restricted to research and unavailable for clinical usage''

===Research Tests===
*Found in blood specimens (6–12 hours) and urine (2–4 days) after usage
*Metabolite (2-oxo-3-hydroxy-LSD) present in urine for a longer time than LSD itself.<ref>Passie, T. "The Pharmacology of Lysergic Acid Diethylamide: A Review". CNS Neuroscience & Therapeutics, Volume 14, Issue 4, pages 295–314, Winter 2008</ref>

==Management==
*Principally supportive
*Assess for signs of trauma or exposure
*Assure patient and staff safety 
*Agitation:
**[[Ativan]] 1-2mg IV, titrate to effect
**[[Haloperidol]] 5-10mg IV, titrate to effect (use as 2nd line agent as may lower [[seizure]] threshold)
''Consider co-ingestions, [[hypoglycemia]], and risk for [[rhabdomyolysis]]<ref>Glaspy, J. "Drugs of Abuse". Emergency Medicine Manual, 6th Ed. Chapt 103, Pgs 502-504.</ref>''

==Disposition==
*Simple LSD ingestion can be safely discharged after a period of observation, once patient has returned to sober baseline and has a safe disposition plan (~4-6 hours)
*Symptoms lasting longer than 8-12hrs can be managed in an observation unit or admitted
**Further work-up and admission is indicated for persistent psychosis or [[altered mental status]],

==See Also==
*[[Hallucinogens]]
*[[Hallucinations]]

==External Links==

==References==
<references/>

[[Category:Toxicology]]