Body stuffing

Background

Hasty ingestion of illicit substances, usually while fleeing law enforcement
Distinct from body packing (deliberate ingestion of well-wrapped large quantities for smuggling)
Key difference: stuffed packets are poorly wrapped → higher risk of rupture and acute toxicity
Most commonly involves cocaine, heroin, methamphetamine, or cannabis

Often brought by police or EMS; patient may be uncooperative or deny ingestion
Symptoms depend on substance and whether packets have ruptured:
- Cocaine: agitation, tachycardia, hypertension, hyperthermia, seizures, cardiac arrest
- Heroin/opioids: altered mental status, respiratory depression, miosis
- Methamphetamine: similar to cocaine — sympathomimetic toxidrome
May be asymptomatic if packets intact

Vital signs and continuous monitoring
ECG: QRS prolongation and arrhythmias (cocaine), QTc prolongation
BMP, CBC
Abdominal X-ray or CT: may visualize packets (sensitivity limited — negative imaging does NOT rule out ingestion)
Urine drug screen (positive result does not differentiate recent use from packet leak)
Serial observation for developing toxicity

Supportive care is mainstay — treat toxicity as it develops
Whole bowel irrigation (GoLYTELY/PEG) if recent ingestion and patient cooperative — 1-2 L/hr until rectal effluent is clear
Cocaine toxicity: benzodiazepines for agitation/seizures, avoid beta-blockers (use IV nitroglycerin or phentolamine for hypertension); sodium bicarbonate for wide QRS
Opioid toxicity: naloxone, titrate to adequate respirations
Activated charcoal is generally NOT recommended (poorly wrapped packets, risk of aspiration)
Surgical retrieval is rarely needed (unlike body packing) — consult surgery only if evidence of obstruction or refractory toxicity

Observation period: minimum 6-8 hours if asymptomatic
Admit: symptomatic patients, evidence of packet rupture, signs of toxicity
Discharge: asymptomatic after observation, passed packets, normal vitals and labs
Consider social work/legal notification per local protocols

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