Body packers
- International "professional" carriers of well packed illicit drugs
- Usually cocaine or heroin, occasionally amphetamines or ecstasy
- Different to body stuffers
- Stuffers = swallowing of relatively small amounts of loosely
wrapped drug because of the fear of arrest
- Packers usually carry 1 kg of drug (in 50 to 100 packets of 8 to 10 g)
- Each packet holds fatal amount of drug
- Drug packets may be machine made (images) - rupture rare
- Layered sheath around drug surrounded by hard wax coating
- Plastic incorporated to alter radiodensity
- Constipating agents e.g. diphenoxylate or loperamide frequently used
Present as:
- Drug-induced toxic effects
- Intestinal obstruction (rare)
- Medical assessment
after arrest (gardai)
Record history:
- drug packets (incl. wrapping). Number pf packets (they do know!)
- GI symptoms
Examination
- Vital signs, mental status, pupil size (heroin or cocaine signs very ominous)
- Bowel sounds,skin findings
- Packets tend to leak before rupture : beware signs
- Gentle PR / PV examination
Investigations
- AXR 85% sensitive: FB or "rosette-like" picture
- +/- CT 90% sensitive: (Hounsfield units cocaine=¡219, heroin=¡520)
- Urine toxicology not recommended (sensitivity 37%)
Treatment
- Opioid poisoning - treat conservatively with continuous naloxone infusion (may need huge doses)
- Beware pulmonary oedema which is not responsive to naloxone (RSI plus ventilation)
- Clinical cocaine package rupture - immediate laparotomy & surgical removal
- Temporising benzos for fitting or hypertension
- No Β-blockers
- ? hypertonic sodium bicarbonate / lignocaine for ventricular dysrhythmias
- Phentolamine or sodium nitroprusside for severe hypertension
- Whole bowel irrigation with "Klean - Prep" is the mainstay of treatment
- 2 litre per hour until results - may need NG administration
- avoid paraffin or pro-kinetic agents
