Klock JC, Boerner U, Becker CE.
“Coma, Hyperthermia, and Bleeding Associated with Massive LSD Overdose, A Report of Eight Cases”.
Clinical Toxicology. 1975;8(2):191-203.
Although there have been many reports of overdose with D-lysergic acid diethylamide (LSD) in humans, little toxicologic data are available. The physiologic effects of LSD in doses greater than 1 mg have not been studied in humans and the lethal dose must be interpolated from animal studies. We performed extensive toxicologic studies on eight people who took large doses of LSD; the results and clinical-toxicologic correlations are reported herein. REPORTS OF CASES On July 29, 1972 four women and four men ranging in age from 19 to 39 years were admitted to the emergency room at San Francisco General Hospital for drug overdose. Following a dinner party, they had "snorted" (inhaled through a straw placed in one nostril) a small amount of cocaine and a quantity of white powder believed to be cocaine. All eight were reported to have snorted at least two "lines" (rows of powder measuring approximately 3 x 4 x 30 mm) of the second substance. Within 5 min they experienced anxiety, restlessness, generalized parasthesias and muscle discomfort, vomiting, and physical collapse. Ten minutes later they were admitted to the emergency room in varying degrees of intoxication (Table 1 and Appendix). Five were comatose when first seen and most were extremely hyperactive with severe visual and auditory hallucinations at some point during their course. Three required endotracheal intubation. and assisted ventilation and three aspirated vomitus. All had sinus tachyeardia, widely dilated and fixed pupils, emesis, flushing, and sweating. Fever developed in four and diarrhea in two. Transient hypertension was present in three patients and no patient had convulsions. All had coagulopathy as manifested by the inability to form firm clots and absence of clot retraction in the blood specimen tubes. Seven had guaiac-positive vomitus and four showed evidence of mild generalized bleeding (microscopic hematuria in two, gross hematuria in two, oozing at venipuncture sites in three and small amounts of blood in the vomitus or stool in four patients). Laboratory data showed normal or negative values (see Appendix) for the following: blood glucose and serum sodium, potassium, and bicarbonate levels, hemoglobin (13.0 to 16.4 gm/dl), platelet Count (186,000 to 458,000/pl), prothrombin time (11.0 to 12.5 sec) and partial thromboplastin time (19.3 to 38.7 see), chest roentgenograms, and electrocardiograms. Results of liver and renal function tests were within normal limits in the three patients studied. Direct examination of the blood clots and results of clot retraction tests on several patients showed friable clots that fell apart easily without dissection, and absence of clot retraction (Fig. 1). Supportive care included respiratory assistance, use of hypothermic blankets, and administration of antibiotics and corticosteroids when indicated. Bleeding was mild and disappeared within 4 to 6 hr. Blood transfusions were unnecessary and all patients recovered completely within 12 hr. All were discharged or left the hospital within 48 hr of admission. No residua were observed in a year of direct follow-up of five patients.