Version June 2024
| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222, or the nearest international regional poison center. Contact information for regional poison centers around the world is available at the website referenced below.[1] |
| History |
| Inquire about type of drug, method of wrapping, number of packets |
| Physical exam |
| Assess for heroin toxicity |
| Depressed mental status, decreased respirations, pinpoint pupils, absent bowel sounds |
| Assess for cocaine toxicity |
| Agitation, hypertension, tachycardia, seizures, cardiac dysrhythmias |
| Assess for evidence of packets on physical examination (abdominal and rectal exams) |
| Assess for evidence of gastrointestinal obstruction or perforation (distension, tenderness) |
| Diagnosis |
| A plain abdominal radiograph is the best screening study |
| If suspicion is high but plain radiograph is negative, CT (or barium enhanced abdominal radiography) should be performed |
| Urine toxicology testing lacks sensitivity as a screening test, but may identify packet content(s) |
| Treatment |
| Asymptomatic |
| Whole bowel irrigation (polyethylene glycol electrolyte lavage solution), 2 L/h plus promotility agent (erythromycin 500 mg IV, or metoclopramide 10 mg IV) |
| Gastrointestinal obstruction or perforation |
| Surgical decontamination |
| Evidence of heroin toxicity |
| Naloxone (high doses may be required: eg, 2 to 5 mg IV, may be given every 5 minutes until patient responsive) |
| Whole bowel irrigation, 2 L/h plus promotility agent |
| Evidence of cocaine toxicity |
| Benzodiazepines (eg, midazolam 1 to 2 mg IV, may be repeated); aggressive supportive care |
| Surgical decontamination |
| Endpoint of therapy |
| Contrast-enhanced abdominal CT (or barium-enhanced radiography) to document clearance of all packets from the GI tract |
Reference:
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