II. Definitions

  1. Body Stuffer
    1. Ingestion of Illicit Drug packets to spontaneously hide their contents (e.g. while being arrested by police)
  2. Body Packer (Drug Mule, as seen in Drug Smuggling)
    1. Ingestion of large quantities (e.g. 100 packets) of professionally wrapped and secured Illicit Drugs
    2. Typically double-wrapped latex containers (Condoms, balloons)
    3. Containers are often covered in wax to ease Swallowing
  3. Body Pusher
    1. Illicit Drug packets inserted into Rectum or vagina

III. Precautions

  1. Course is unpredictable
  2. Variable quantity of ingested substance
  3. Variable packaging of substance (and potential for absorption)

IV. Imaging

  1. Abdominal XRay
    1. Typically confirms diagnosis
  2. CT Imaging
    1. May be indicated in unclear diagnosis or in complication (e.g. Small Bowel Obstruction)

V. Diagnostics

  1. Endoscopy is typically not indicated (risk of package rupture)

VI. Management

  1. Monitoring
    1. Obtain Intravenous Access
    2. Continuous cardiac monitoring
      1. Arrhythmia
      2. Tachycardia
      3. QRS Widening (e.g. Sympathomimetic Toxicity)
    3. Toxidromes
      1. Consult poison control
      2. Sympathomimetic Toxicity (e.g. Cocaine Toxicity)
        1. See Sympathomimetic Toxicity for management protocol
      3. Opioid Overdose
        1. Naloxone infusion is typically used
  2. Detoxification
    1. Offer to all awake, alert, cooperative patients (including asymptomatic patients)
    2. Start: Activated Charcoal 1 g/kg or at least 50 g (without Sorbitol)
      1. Binds any drug leaking from packaging
    3. Next: Whole Bowel Irrigation
      1. Polyethylene glycolElectrolyte solution (PEG-ELS 1-2 Liters/hour)
      2. Administer Antiemetics to allow patient to tolerate PEG-ELS
      3. Consider placing Nasogastric Tube to deliver Polyethylene glycol
      4. Continue until packets pass in stool AND passage of packet-free stools, clear fluid output
        1. Expect 24 hour or more course
    4. Precautions
      1. Avoid endoscopy (risk of packet rupture)
      2. Avoid Gastric Lavage (low yield of returning packets, and risk of packet rupture)
  3. Symptomatic Patients
    1. Treat based on Toxidrome of ingested substance
    2. Admit all symptomatic patients
    3. Consult surgery in all symptomatic patients
  4. Asymptomatic patients
    1. Observe for at least 6 hours
    2. Consult with poison control
      1. Some will recommend 12 hour observation for certain suspected substances (e.g. Fentanyl-laced)
  5. Leaving Against Medical Advice
    1. See Against Medical Advice
    2. See CURVES Capacity Assessment Tool
    3. Provide Informed Consent regarding risk of life threatening consequences related to their ingestion
    4. Patients with Decision-Making Capacity may refuse treatment and be discharged per their wishes

VII. References

  1. Swadron and Nordt in Herbert (2021) EM:Rap 21(9): 3-4
  2. Swadron and Nordt in Swadron (2022) EM:Rap 22(4): 6-7

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