Lysergic Acid Diethylamide (LSD) Confirmation, Urine
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Lysergic acid diethylamide (LSD) is an extremely potent psychedelic ergot alkaloid derived from the fungus, Claviceps purpurea(1). The drug LSD binds to serotonin receptors in the central nervous system and acts as a serotonin agonist.
The clearance half-life of LSD averages 3 to 4 hours. It takes 5 to 7 half-lives to clear 98% of a drug dose. Therefore, the presence of LSD greater than the lower limit of quantification (LOQ; cutoff concentration) indicates exposure to LSD within 1 day.(2)
LSD is metabolized to 2-oxo-3-hydroxy-LSD, which is present at concentrations 16 to 43 times higher than LSD, and is likely to be present in urine for up to 4 days after last exposure.(3,4)
Confirming use of lysergic acid diethylamide
Lysergic acid diethylamide (LSD) exposure is confirmed if LSD is present >0.5 ng/mL or if 2-oxo-3-hydroxy-LSD is present >5.0 ng/mL.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
The liquid chromatography-tandem mass spectrometry (LC-MS/MS) test is not subject to any known interference.
Positive immunoassay screening results should be considered presumptive due to documented cross-reactivities with the lysergic acid diethylamide reagent antibody.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Positives are reported with a quantitative LC-MS/MS result.
LSD BY LC-MS/MS
2-OXO-3-HYDROXY-LSD BY LC-MS/MS
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Babu KM, Ferm RP: Hallucinogens. In Goldfrank's Toxicologic Emergencies. Edited by Flomenbaum, Goldfrank, Hoffman, Howland, Lewin, and Nelson. 8th edition. New York. McGraw-Hill Book Company, 2006 pp 1202-1211
2. Baselt RC: Lysergic Acid Diethylamide. In Dispositition of Toxic Drugs and Chemical in Man, Edited by RC Baselt. 8th edition. Foster City, CA. Biomedical Publications, 2008 pp 871-874
3. Johansen SS, Jensen JL: Liquid chromatography-tandem mass spectrometry determination of LSD, ISO-LSD, and the main metabolite 2-oxo-3-hydroxy-LSD in forensic samples and application in a forensic case. J Chromatogr B Analyt Technol Biomed Life Sci 2005;825:21-28
4. Klette KL, Anderson CJ, Poch GK, et al: Metabolism of lysergic acid diethylamide (LSD) to 2-oxo-3-hydroxy LSD (O-H-LSD) in human liver microsomes and cryopreserved human hepatocytes. J Anal Toxicol 2000;24:550-556