Body packing
Background
- Body packers, also called "mules", swallow or insert drug filled packets into body cavity, usually to smuggle them across borders
- Packets usually made of several layers of latex and outer wax coating
- Each packet contains about 10g of drug and body packers ingest between 50 to 100 drug containers at a time[1]
- Sometimes packets are inserted rectally or vaginally
- Vs body stuffing, ingestion of illicit drugs while pursued by law enforcement; usually small quantity
Clinical Features
- Situations in which body packers present to the ED:
- Asymptomatic but in custody
- Signs of Toxidromes from a ruptured packet
- Signs of bowel obstruction or perforation
Differential Diagnosis
Evaluation
- History and physical
- Type of drug
- Type of packet wrapping (more likely to rupture or leak of home made)
- Number of packets ingested
- GI symptoms (pain, distention, obstipation)
- Other drug use
- Imaging: KUB, CT abdomen pelvis
- Urine drug screen: may be misleading
Management
- Asymptomatic patients
- Expectant management, no surgery, close monitoring in ICU until passage of all packets
- Whole bowel irrigation with polyethylene glycol via NGT at 2L per hour
- Activated charcoal more useful in body stuffers
- Opioid toxicity
- Naloxone: may require very high doses
- 2 to 5mg IV initially, repeat 2mg q5min until responsive
- then total amount required for response should be given every hour as continuous drip
- Naloxone: may require very high doses
- Sympathomimetic toxicity
- Immediate OR for surgical decontamination
- No place for conservative management
- Pharmacologic stabilization appropriate but not definitive, do not delay transfer to the OR
- Hyperthermia
- Active external cooling
- IV benzodiazepines
- Hyperthermia
Disposition
See Also
External Links
References
- ↑ Booker RJ. Packers, pushers and stuffers--managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J. 2009;26(5):316-20.