Extreme Hyperthermia From LSD

A case report of extreme hyperthermia after LSD ingestion should be interpreted cautiously, as the symptoms—hyperactivity, unresponsiveness, mildly elevated blood pressure, increased heart rate, and slightly dilated reactive pupils—are also consistent with amphetamine overdose or abuse of potent anticholinergics like piperidyl benzilate or high doses of atropine and scopolamine. The patient's amnesia for the episode is not typical of LSD or amphetamine but is characteristic of anticholinergic abuse. The only feature arguing against an anticholinergic was that pupils were not widely dilated with minimal light response. Physicians should consider these alternative causes when treating unresponsive hyperthermic patients suspected of drug ingestion.

Study at a glance

Abstract

To the Editor.— Friedman and Hirsch's article, "Extreme Hyperthermia after LSD Ingestion," (217:1549-1550, 1971) should be interpreted with caution. The case report of a hyperactive, verbally unresponsive patient with mildly elevated blood pressure, increased heart rate, and slightly dilated and reactive pupils is consistent with amphetamine as well as LSD overdose. The amnesia for the episode experienced by the patient is not particularly characteristic of either an amphetamine or LSD overdose but is very characteristic of abuse of illicitly available potent centrally acting anticholinergics (such as piperidyl benzilate) and high doses of over-the-counter anticholinergics (eg, atropine and scopolamine). The only clinical feature in the patient described that would argue against an anticholinergic having been abused is the fact that the patient's pupils were not widely dilated with minimal response to light. A reading of the article might lead a physician to treat an unresponsive hyperthermic patient suspected of drug