Body stuffing: Difference between revisions
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*Hasty ingestion of illicit substances, usually while fleeing law enforcement | *Hasty ingestion of illicit substances, usually while fleeing law enforcement | ||
*Distinct from [[body packing]] (deliberate ingestion of well-wrapped large quantities for smuggling) | *Distinct from [[body packing]] (deliberate ingestion of well-wrapped large quantities for smuggling) | ||
*Key difference: stuffed packets are | *Key difference: stuffed packets are poorly wrapped → higher risk of rupture and acute toxicity | ||
*Most commonly involves cocaine, heroin, methamphetamine, or cannabis | *Most commonly involves cocaine, heroin, methamphetamine, or cannabis | ||
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*Often brought by police or EMS; patient may be uncooperative or deny ingestion | *Often brought by police or EMS; patient may be uncooperative or deny ingestion | ||
*Symptoms depend on substance and whether packets have ruptured: | *Symptoms depend on substance and whether packets have ruptured: | ||
** | **Cocaine: agitation, tachycardia, hypertension, hyperthermia, seizures, cardiac arrest | ||
**'''Heroin/opioids''': altered mental status, respiratory depression, miosis | **'''Heroin/opioids''': altered mental status, respiratory depression, miosis | ||
** | **Methamphetamine: similar to cocaine — sympathomimetic toxidrome | ||
*May be asymptomatic if packets intact | *May be asymptomatic if packets intact | ||
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==Management== | ==Management== | ||
* | *Supportive care is mainstay — treat toxicity as it develops | ||
* | *Whole bowel irrigation (GoLYTELY/PEG) if recent ingestion and patient cooperative — 1-2 L/hr until rectal effluent is clear | ||
* | *Cocaine toxicity: benzodiazepines for agitation/seizures, avoid beta-blockers (use IV [[nitroglycerin]] or [[phentolamine]] for hypertension); sodium bicarbonate for wide QRS | ||
* | *Opioid toxicity: [[naloxone]], titrate to adequate respirations | ||
*Activated charcoal is generally NOT recommended (poorly wrapped packets, risk of aspiration) | *Activated charcoal is generally NOT recommended (poorly wrapped packets, risk of aspiration) | ||
* | *Surgical retrieval is rarely needed (unlike body packing) — consult surgery only if evidence of obstruction or refractory toxicity | ||
==Disposition== | ==Disposition== | ||
Latest revision as of 09:30, 22 March 2026
Background
- Hasty ingestion of illicit substances, usually while fleeing law enforcement
- Distinct from body packing (deliberate ingestion of well-wrapped large quantities for smuggling)
- Key difference: stuffed packets are poorly wrapped → higher risk of rupture and acute toxicity
- Most commonly involves cocaine, heroin, methamphetamine, or cannabis
Clinical Features
- Often brought by police or EMS; patient may be uncooperative or deny ingestion
- Symptoms depend on substance and whether packets have ruptured:
- Cocaine: agitation, tachycardia, hypertension, hyperthermia, seizures, cardiac arrest
- Heroin/opioids: altered mental status, respiratory depression, miosis
- Methamphetamine: similar to cocaine — sympathomimetic toxidrome
- May be asymptomatic if packets intact
Evaluation
- Vital signs and continuous monitoring
- ECG: QRS prolongation and arrhythmias (cocaine), QTc prolongation
- BMP, CBC
- Abdominal X-ray or CT: may visualize packets (sensitivity limited — negative imaging does NOT rule out ingestion)
- Urine drug screen (positive result does not differentiate recent use from packet leak)
- Serial observation for developing toxicity
Management
- Supportive care is mainstay — treat toxicity as it develops
- Whole bowel irrigation (GoLYTELY/PEG) if recent ingestion and patient cooperative — 1-2 L/hr until rectal effluent is clear
- Cocaine toxicity: benzodiazepines for agitation/seizures, avoid beta-blockers (use IV nitroglycerin or phentolamine for hypertension); sodium bicarbonate for wide QRS
- Opioid toxicity: naloxone, titrate to adequate respirations
- Activated charcoal is generally NOT recommended (poorly wrapped packets, risk of aspiration)
- Surgical retrieval is rarely needed (unlike body packing) — consult surgery only if evidence of obstruction or refractory toxicity
Disposition
- Observation period: minimum 6-8 hours if asymptomatic
- Admit: symptomatic patients, evidence of packet rupture, signs of toxicity
- Discharge: asymptomatic after observation, passed packets, normal vitals and labs
- Consider social work/legal notification per local protocols