Makindo Medical Notes

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💊 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-HT_2A 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

• StatPearls: Lysergic Acid Diethylamide (LSD) Toxicity
• CAMH: LSD and Hallucinogens
• Passie T, et al. The pharmacology of LSD: a review. CNS Neurosci Ther. 2008;14(4):295–314.

🧠 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. 🚑