Pediatric emergency medicine trisk 3145 3145
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serotonin (5-hydroxytryptamine). This class of drugs is often used orally or
sublingually either in powder form or on blotter paper.
Clinical Considerations. For LSD, the somatic symptoms of dizziness, weakness,
drowsiness, nausea, and paresthesias may be observed after one oral dose of 0.5
to 2 mcg/kg. Between the dose range of 1 and 16 mcg/kg, the intensity of LSD’s
psychoactive effects is proportional to the dose. A typical LSD “hit” is 200 to 400
mcg. A high degree of tolerance develops after three to four daily doses, with
sensitivity returning after a drug-free interval.
In general, the somatic effects of hallucinogens are sympathomimetic and
serotonergic and include pupillary dilation, hypertension, tachycardia,
hyperreflexia, and hyperpyrexia. Doses of LSD as low as 20 to 25 mcg can
produce CNS effects such as euphoria, visual perceptual distortions, alteration of
subjective time so time passes slowly, lability of mood, or even an acute panic
episode. Hallucinations and psychosis with hyperalertness are commonly seen.
The clinical duration of action of LSD is somewhat dose dependent but averages
6 to 12 hours. The psychedelic state includes a heightened awareness of sensory
input, often accompanied by an enhanced sense of clarity but a diminished
control over what is experienced. There is often a feeling that one part of the self
is a passive observer while another part receives vivid sensory input. The ability
to separate one object from another or to separate self from the environment is
diminished. There is an enhanced sense of oneness with humanity. Some of the
LSD analogs and 2C drugs may cause more significant clinical toxicity, including
seizures, serotonin syndrome, rhabdomyolysis, and acute kidney injury.
Pay specific attention to mental status and vital signs, including temperature.
Because LSD is ingested in minuscule doses and onset of symptoms occurs hours
after ingestion, GI decontamination is unnecessary, unless coingestion is
suspected. In cases of significant clinical toxicity, consider laboratory testing for
creatine kinase and renal function. LSD and analogs are not typically included on
standard urine toxicology screens and ongoing evolution of emerging compounds
limits detection even on more comprehensive testing. Management is thus based
on history of exposure, suspicion of exposure based on assessment, and clinical
severity of presentation.
Clinical management involves placing the patient in a quiet room. Someone
who knows the patient may be able to quietly “talk down” and reassure the
patient. The patient’s loss of boundaries and fear of fragmentation or selfdisintegration create a need for a structuring or a supportive environment.
