Body packing - Revision history

Danbot: Add MedicationDose entry for naloxone

2026-03-20T21:14:09Z

Add MedicationDose entry for naloxone

← Older revision		Revision as of 21:14, 20 March 2026
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	**Passage of 2 or 3 packet free bowel movements is not sufficient<ref>Rousset P. Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography-a prospective study. Eur Radiol. 2013;23(8):2146-55.</ref>		**Passage of 2 or 3 packet free bowel movements is not sufficient<ref>Rousset P. Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography-a prospective study. Eur Radiol. 2013;23(8):2146-55.</ref>


			==Medication Dosing==
			{{MedicationDose
			\| drug = Naloxone
			\| dose = 2-5mg IV initially, repeat 2mg q5min until responsive; then continuous infusion at total response dose/hr
			\| route = IV
			\| context = Opioid packet rupture
			\| indication = Body packing
			\| population = Adult
			}}

	==See Also== <!--T:12-->		==See Also== <!--T:12-->

Ostermayer: Marked this version for translation

2026-01-06T21:25:14Z

Marked this version for translation

← Older revision		Revision as of 21:25, 6 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	[[File:Blausen 0817 SmallIntestine Anatomy.png\|thumb\|Small bowel anatomy with surrounding structures.]]		[[File:Blausen 0817 SmallIntestine Anatomy.png\|thumb\|Small bowel anatomy with surrounding structures.]]
	[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]		[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]
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	==Clinical Features==		==Clinical Features== <!--T:3-->

			<!--T:4-->
	*Situations in which body packers present to the ED:		*Situations in which body packers present to the ED:
	**Asymptomatic but in custody		**Asymptomatic but in custody
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:5-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:6-->

			<!--T:7-->
	[[File:PMC3522363 iranjradiol-08-205-g002.png\|thumb\|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]		[[File:PMC3522363 iranjradiol-08-205-g002.png\|thumb\|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]
	[[File:Bolletjes.jpg\|thumb\|Abdominal X-ray showing swallowed packages of cocaine.]]		[[File:Bolletjes.jpg\|thumb\|Abdominal X-ray showing swallowed packages of cocaine.]]
Line 48:		Line 51:


	==Management==		==Management== <!--T:8-->

			<!--T:9-->
	*Asymptomatic patients		*Asymptomatic patients
	**Expectant management, no surgery, close monitoring in ICU until passage of all packets		**Expectant management, no surgery, close monitoring in ICU until passage of all packets
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	==Disposition==		==Disposition== <!--T:10-->

			<!--T:11-->
	*Admit all to ICU, regardless of symptoms		*Admit all to ICU, regardless of symptoms
	*Complete GI decontamination by contrast CT should be documented prior to discharge		*Complete GI decontamination by contrast CT should be documented prior to discharge
Line 84:		Line 89:


	==See Also==		==See Also== <!--T:12-->

			<!--T:13-->
	*[[Special:MyLanguage/Body stuffing\|Body stuffing]]		*[[Special:MyLanguage/Body stuffing\|Body stuffing]]
	*[[Special:MyLanguage/Drugs of abuse\|Drugs of abuse]]		*[[Special:MyLanguage/Drugs of abuse\|Drugs of abuse]]
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	==External Links==		==External Links== <!--T:14-->


	==References==		==References== <!--T:15-->

			<!--T:16-->
	<references/>		<references/>

			<!--T:17-->
	[[Category:GI]]		[[Category:GI]]
	[[Category:Toxicology]]		[[Category:Toxicology]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:45:10Z

Prepared the page for translation

← Older revision		Revision as of 21:45, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Blausen 0817 SmallIntestine Anatomy.png\|thumb\|Small bowel anatomy with surrounding structures.]]		[[File:Blausen 0817 SmallIntestine Anatomy.png\|thumb\|Small bowel anatomy with surrounding structures.]]
	[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]		[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]
Line 7:		Line 11:
	*Each packet contains about 10g of drug and body packers ingest between 50 to 100 drug containers at a time<ref>Booker RJ. Packers, pushers and stuffers--managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J. 2009;26(5):316-20.</ref>		*Each packet contains about 10g of drug and body packers ingest between 50 to 100 drug containers at a time<ref>Booker RJ. Packers, pushers and stuffers--managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J. 2009;26(5):316-20.</ref>
	*Sometimes packets are inserted rectally or vaginally		*Sometimes packets are inserted rectally or vaginally
	*Distinct from [[Body stuffing]] (ingestion of illicit drugs while pursued by law enforcement, usually small quantity)		*Distinct from [[Special:MyLanguage/Body stuffing\|Body stuffing]] (ingestion of illicit drugs while pursued by law enforcement, usually small quantity)

			</translate>
	{{FB types}}		{{FB types}}
			<translate>


	==Clinical Features==		==Clinical Features==

	*Situations in which body packers present to the ED:		*Situations in which body packers present to the ED:
	**Asymptomatic but in custody		**Asymptomatic but in custody
	**Signs of [[toxidromes]] from a ruptured packet		**Signs of [[Special:MyLanguage/toxidromes\|toxidromes]] from a ruptured packet
	**Signs of [[bowel obstruction]] or perforation		**Signs of [[Special:MyLanguage/bowel obstruction\|bowel obstruction]] or perforation
	*History and physical		*History and physical
	**Type of drug		**Type of drug
	**Type of packet wrapping (more likely to rupture or leak if home made)		**Type of packet wrapping (more likely to rupture or leak if home made)
	**Number of packets ingested		**Number of packets ingested
	**GI symptoms ([[abdominal pain\|pain]], distention, obstipation)		**GI symptoms ([[Special:MyLanguage/abdominal pain\|pain]], distention, obstipation)
	**Other drug use		**Other drug use


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Drugs of abuse types}}		{{Drugs of abuse types}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:PMC3522363 iranjradiol-08-205-g002.png\|thumb\|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]		[[File:PMC3522363 iranjradiol-08-205-g002.png\|thumb\|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]
	[[File:Bolletjes.jpg\|thumb\|Abdominal X-ray showing swallowed packages of cocaine.]]		[[File:Bolletjes.jpg\|thumb\|Abdominal X-ray showing swallowed packages of cocaine.]]
	[[File:PMC3522363 iranjradiol-08-205-g005.png\|thumb\|(A) plain x-ray reveals several uniform radiopaque packets; B-C, Abdominal CT scan without oral contrast shows numerous randomly distributed packets within the small bowel and colon. Their density is 150-170HU which is compatible with the density of opium.]]		[[File:PMC3522363 iranjradiol-08-205-g005.png\|thumb\|(A) plain x-ray reveals several uniform radiopaque packets; B-C, Abdominal CT scan without oral contrast shows numerous randomly distributed packets within the small bowel and colon. Their density is 150-170HU which is compatible with the density of opium.]]
	*Imaging: KUB, CT abdomen pelvis		*Imaging: KUB, CT abdomen pelvis
	*[[Urine drug screen]]: may be misleading		*[[Special:MyLanguage/Urine drug screen\|Urine drug screen]]: may be misleading


	==Management==		==Management==

	*Asymptomatic patients		*Asymptomatic patients
	**Expectant management, no surgery, close monitoring in ICU until passage of all packets		**Expectant management, no surgery, close monitoring in ICU until passage of all packets
	**[[Whole bowel irrigation]] with polyethylene glycol via NGT at 2L per hour		**[[Special:MyLanguage/Whole bowel irrigation\|Whole bowel irrigation]] with polyethylene glycol via NGT at 2L per hour
	**[[Activated charcoal]] more useful in body stuffers		**[[Special:MyLanguage/Activated charcoal\|Activated charcoal]] more useful in body stuffers
	*[[Opioid toxicity]]		*[[Special:MyLanguage/Opioid toxicity\|Opioid toxicity]]
	**[[Naloxone]]: may require very high doses		**[[Special:MyLanguage/Naloxone\|Naloxone]]: may require very high doses
	***2 to 5mg IV initially, repeat 2mg q5min until responsive		***2 to 5mg IV initially, repeat 2mg q5min until responsive
	***then total amount required for response should be given every hour as continuous drip		***then total amount required for response should be given every hour as continuous drip
	*[[Sympathomimetic toxicity]]		*[[Special:MyLanguage/Sympathomimetic toxicity\|Sympathomimetic toxicity]]
	**Immediate OR for surgical decontamination		**Immediate OR for surgical decontamination
	**No place for conservative management		**No place for conservative management
	**Pharmacologic stabilization appropriate but not definitive, do not delay transfer to the OR		**Pharmacologic stabilization appropriate but not definitive, do not delay transfer to the OR
	***[[Hyperthermia]]		***[[Special:MyLanguage/Hyperthermia\|Hyperthermia]]
	****Active external cooling		****Active external cooling
	****IV [[benzodiazepines]] ([[midazolam]] 1 to 2mg IV or [[diazepam]] 5 to 10 mg IV, rapid escalation in dosing)		****IV [[Special:MyLanguage/benzodiazepines\|benzodiazepines]] ([[Special:MyLanguage/midazolam\|midazolam]] 1 to 2mg IV or [[Special:MyLanguage/diazepam\|diazepam]] 5 to 10 mg IV, rapid escalation in dosing)
	***[[Hypertension]]		***[[Special:MyLanguage/Hypertension\|Hypertension]]
	****IV [[benzodiazepines]], [[phentolamine]], [[nitroprusside]], [[nitroglycerin]],, or [[nicardipine]]		****IV [[Special:MyLanguage/benzodiazepines\|benzodiazepines]], [[Special:MyLanguage/phentolamine\|phentolamine]], [[Special:MyLanguage/nitroprusside\|nitroprusside]], [[Special:MyLanguage/nitroglycerin\|nitroglycerin]],, or [[Special:MyLanguage/nicardipine\|nicardipine]]
	***[[Seizures]]		***[[Special:MyLanguage/Seizures\|Seizures]]
	****IV [[benzodiazepines]], followed by [[propofol]] if needed		****IV [[Special:MyLanguage/benzodiazepines\|benzodiazepines]], followed by [[Special:MyLanguage/propofol\|propofol]] if needed
	***[[Ventricular dysrhythmias]]		***[[Special:MyLanguage/Ventricular dysrhythmias\|Ventricular dysrhythmias]]
	****IV [[benzodiazepines]], followed by hypertonic [[sodium bicarbonate]] if wide QRS		****IV [[Special:MyLanguage/benzodiazepines\|benzodiazepines]], followed by hypertonic [[Special:MyLanguage/sodium bicarbonate\|sodium bicarbonate]] if wide QRS
	*[[bowel obstruction\|Obstruction]] or perforation		*[[Special:MyLanguage/bowel obstruction\|Obstruction]] or perforation
	**OR for immediate ex-lap, then advanced imaging study to document a clear GI tract		**OR for immediate ex-lap, then advanced imaging study to document a clear GI tract
	**Endoscopic removal highly controversial, risk of packet perforation		**Endoscopic removal highly controversial, risk of packet perforation


	==Disposition==		==Disposition==

	*Admit all to ICU, regardless of symptoms		*Admit all to ICU, regardless of symptoms
	*Complete GI decontamination by contrast CT should be documented prior to discharge		*Complete GI decontamination by contrast CT should be documented prior to discharge
	**History is unreliable		**History is unreliable
	**Passage of 2 or 3 packet free bowel movements is not sufficient<ref>Rousset P. Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography-a prospective study. Eur Radiol. 2013;23(8):2146-55.</ref>		**Passage of 2 or 3 packet free bowel movements is not sufficient<ref>Rousset P. Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography-a prospective study. Eur Radiol. 2013;23(8):2146-55.</ref>


	==See Also==		==See Also==
	*[[Body stuffing]]
	*[[Drugs of abuse]]		*[[Special:MyLanguage/Body stuffing\|Body stuffing]]
	*[[Ingested foreign body]]		*[[Special:MyLanguage/Drugs of abuse\|Drugs of abuse]]
	*[[Rectal foreign body]]		*[[Special:MyLanguage/Ingested foreign body\|Ingested foreign body]]
			*[[Special:MyLanguage/Rectal foreign body\|Rectal foreign body]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Toxicology]]		[[Category:Toxicology]]
			</translate>

Rossdonaldson1: /* Background */

2024-02-28T22:48:32Z

Background

← Older revision		Revision as of 22:48, 28 February 2024
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Blausen 0817 SmallIntestine Anatomy.png\|thumb\|Small bowel anatomy with surrounding structures.]]
	[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]		[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]
	[[File:PMC3522363 iranjradiol-08-205-g001.png\|thumb\|Illicit drugs evacuated from a body packer. They are packed tightly and wrapped into aluminum foil.]]		[[File:PMC3522363 iranjradiol-08-205-g001.png\|thumb\|Illicit drugs evacuated from a body packer. They are packed tightly and wrapped into aluminum foil.]]

Rossdonaldson1 at 12:03, 23 April 2022

2022-04-23T12:03:32Z

← Older revision		Revision as of 12:03, 23 April 2022
Line 7:		Line 7:
	*Sometimes packets are inserted rectally or vaginally		*Sometimes packets are inserted rectally or vaginally
	*Distinct from [[Body stuffing]] (ingestion of illicit drugs while pursued by law enforcement, usually small quantity)		*Distinct from [[Body stuffing]] (ingestion of illicit drugs while pursued by law enforcement, usually small quantity)

			{{FB types}}

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Differential Diagnosis */

2022-04-23T11:54:49Z

Differential Diagnosis

← Older revision		Revision as of 11:54, 23 April 2022
Line 21:		Line 21:

	==Differential Diagnosis==		==Differential Diagnosis==
			{{Drugs of abuse types}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Evaluation */

2022-04-23T11:53:53Z

Evaluation

← Older revision		Revision as of 11:53, 23 April 2022
Line 25:		Line 25:
	[[File:PMC3522363 iranjradiol-08-205-g002.png\|thumb\|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]		[[File:PMC3522363 iranjradiol-08-205-g002.png\|thumb\|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]
	[[File:Bolletjes.jpg\|thumb\|Abdominal X-ray showing swallowed packages of cocaine.]]		[[File:Bolletjes.jpg\|thumb\|Abdominal X-ray showing swallowed packages of cocaine.]]
			[[File:PMC3522363 iranjradiol-08-205-g005.png\|thumb\|(A) plain x-ray reveals several uniform radiopaque packets; B-C, Abdominal CT scan without oral contrast shows numerous randomly distributed packets within the small bowel and colon. Their density is 150-170HU which is compatible with the density of opium.]]
	*Imaging: KUB, CT abdomen pelvis		*Imaging: KUB, CT abdomen pelvis
	*[[Urine drug screen]]: may be misleading		*[[Urine drug screen]]: may be misleading

Rossdonaldson1: /* Background */

2022-04-23T11:52:08Z

Background

← Older revision		Revision as of 11:52, 23 April 2022
Line 1:		Line 1:
	==Background==		==Background==
	[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]		[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]
			[[File:PMC3522363 iranjradiol-08-205-g001.png\|thumb\|Illicit drugs evacuated from a body packer. They are packed tightly and wrapped into aluminum foil.]]
	*Body packers, also called "mules", swallow or insert drug filled packets into body cavity, usually to smuggle them across borders		*Body packers, also called "mules", swallow or insert drug filled packets into body cavity, usually to smuggle them across borders
	*Packets usually made of several layers of latex and outer wax coating		*Packets usually made of several layers of latex and outer wax coating

Rossdonaldson1: /* Evaluation */

2022-04-23T11:50:24Z

Evaluation

← Older revision		Revision as of 11:50, 23 April 2022
Line 23:		Line 23:
	==Evaluation==		==Evaluation==
	[[File:PMC3522363 iranjradiol-08-205-g002.png\|thumb\|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]		[[File:PMC3522363 iranjradiol-08-205-g002.png\|thumb\|Abdominal x-ray reveals multiple, oval radiopaque packets throughout the abdomen.]]
			[[File:Bolletjes.jpg\|thumb\|Abdominal X-ray showing swallowed packages of cocaine.]]
	*Imaging: KUB, CT abdomen pelvis		*Imaging: KUB, CT abdomen pelvis
	*[[Urine drug screen]]: may be misleading		*[[Urine drug screen]]: may be misleading

Rossdonaldson1 at 11:49, 23 April 2022

2022-04-23T11:49:25Z

← Older revision		Revision as of 11:49, 23 April 2022
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Bodypacks.jpg\|thumb\|Seized cocaine containers (i.e. bodypacks).]]
	*Body packers, also called "mules", swallow or insert drug filled packets into body cavity, usually to smuggle them across borders		*Body packers, also called "mules", swallow or insert drug filled packets into body cavity, usually to smuggle them across borders
	*Packets usually made of several layers of latex and outer wax coating		*Packets usually made of several layers of latex and outer wax coating