Management of patients with internally concealed drugs of abuse (body packer)

CNS: central nervous system; CT: computed tomogaphy; IV: intravenous; L: liter; min: minute; WBI: whole bowel irrigation.

* Most body packers generally know exactly the number and contents of their packages.

¶ Opioid toxidrome: CNS depression, decreased respiratory rate, miotic pupils. Sympathomimetic toxidrome: agitation, hypertension, tachycardia, mydriatic pupils, diaphoresis; severe cases can include seizures, hyperthermia, myocardial ischemia, heart failure, ventricular dysrhythmias, and coma. Other toxidromes occur less commonly and patients should be managed on an individual basis. In general, it is reasonable to manage similar to sympathomimetic agents for patients who have ingested drugs with known life-threating toxicity, and to manage similar to opioids for other agents.

Δ Benzodiazepines include midazolam 1 to 2 mg IV and diazepam 5 to 10 mg IV, repeat as necessary. Lorazepam 2 to 4 mg IV is also an option for seizures.

◊ The active cooling technique should be individualized to clinical circumstances (eg, need for monitoring, IV access, procedures) and available resources. Options include ice/cold water immersion, water ice therapy on porous stretcher, and tarp assisted cooling. Refer to UpToDate content on severe nonexertional hyperthermia.

§ WBI typically requires the adult patient to drink 2 L per hour of a polyethylene glycol-electrolyte lavage solution, which is often difficult voluntarily, and a nasogastric tube is needed to ensure an adequate rate of administration; +/– promotility agent (eg, metoclopramide 10 mg IV).