Lysergic acid diethylamide toxicity
Background
d-lysergic acid diethylamide, more commonly known as LSD, was first synthesized in 1938 by the chemist Albert Hofmann in efforts to chemically create a blood stimulant.[1]In 1943, Hoffman accidently ingested LSD for the first time, discovering its hallucinagenic properties, reportedly seeing "an uninterrupted stream of fantastic pictures, extraordinary shapes with intense, kaleidoscopelike play of colors."[2] LSD became very popular in the 1960's and 1970's, making it a very important part of the "counterculture" movement, encouraging participants to "turn on, tune in, drop out."[3]
Mechanism
Serotonin-like agents, like LSD, have similar chemical properties of serotonin. These are 5-HT2 agonists, mediating excitatory neurotransmitter release.[4] LSD also binds to dopaminergic receptors, contributing to its psychogenic affects.[5]
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.
Route of administration can be PO (most common), IM, or IV.[6] 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
Tolerance to LSD-25 builds up over consistent use and cross-tolerance has been demonstrated between LSD, mescaline and psilocybin.
Clinical Features
Differential Diagnosis
Serotonin-Like Agents
- LSD
- Psilocybin and psilocin dimethyltryptamine (DMT) and 5-methoxy- dimethyltryptamine (5-MeO-DMT)
- Naturally occurring plants like :Hawaiian baby woodrose (Argyreia nervosa), Hawaiian woodrose (Merremia tuberosa), morning glory (Ipomoea violacea), and olili- uqui (Rivea corymbosa)
Enactogens
- Designer amphetamines - Bath Salts, Ecstasy (MDMA)
- Mescaline (Peyote)
Dissociative Agents
- PCP
- Ketamine
- Dextromethorphan
Plant-based Hallucinogenics
- Marijuana
- Salvia
- Absinthe
- Isoxazole Mushrooms
Psychiatric Illnesses
- Schizophrenia
- Schizo-affective disorder
- Dementia
- Delirium
Diagnosis
Management
Disposition
See Also
External Links
References
- ↑ Hofmann A. "Die Geschichte des LSD-25". Triangel Sandoz Zeitschrift fur Medizinische Wissenschaften. 1955;2(3):117-24. (as cited in Ott J. Pharmacotheon. 1993. pg 123.)
- ↑ http://www.theatlantic.com/health/archive/2014/09/the-accidental-discovery-of-lsd/379564/
- ↑ Leary, T. "Flashbacks." Tarcher, 1997.
- ↑ Ly, B. "Hallucinogens", Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th Ed. Pgs 2010-2012
- ↑ 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.
- ↑ Passie, T. "The Pharmacology of Lysergic Acid Diethylamide: A Review". CNS Neuroscience & Therapeutics, Volume 14, Issue 4, pages 295–314, Winter 2008