TOXICOLOGYCOMPLICATIONS
■ Similar to cocaine
■ Hyponatremia may occur with MDMAand is associated with
■ Increased release of vasopressin (ADH)
■ Isotonic fluid loss related to dancing and sweating, replaced with free
water
■ Serotonin syndrome: With MDMA
Opiates
See “Opiates,” page 366.
BODYPACKERS ANDSTUFFERS
Body packers
■ Purposefully swallow large amounts of prepared packets of drugs (cocaine,
heroin most common) for the purpose of smuggling
■ Packets are less likely to rupture, but contain potentially lethal amounts of
drug.
Body stuffers
■ Rapidly consume bags or vials of drugs, to avoid police detection
■ Typically smaller amount of drug ingested, but increased chance of expo-
sure given the poorly packaged drug load
SYMPTOMS/EXAM
■ Toxidrome consistent with packaged substance
DIAGNOSIS
■ Clinical diagnosis is based on history and examination.
■ Abdominal radiography (X-ray or CT) may identify packets, vials.
■ May help assess body burden and location
■ Repeat CT with contrast may document passage of drug.
TREATMENT
■ Supportive therapy
■ Treat toxidrome, if present.
■ Multiple-dose activated charcoal and whole-bowel irrigation to bind any
available drug and decrease transit time, respectively
■ A body packer who develops symptoms should undergo emergent laporo-
tomy to remove the packets.
PCP
MECHANISM/TOXICITY
■ σReceptor stimulation →dysphoria.
■ Antagonism of glutamate activity at NMDA receptor →sedation.
Stuffers are more likely to be
symptomatic, but packers, if
symptomatic, are more likely
to have lethal amounts of
drug.