UMEM Educational Pearls

Category: Toxicology

Title: Body stuffers how long should they be observed in the ED?

Keywords: body stuffers, observation period (PubMed Search)

Posted: 8/20/2015 by Hong Kim, MD, MPH (Updated: 1/23/2022)
Click here to contact Hong Kim, MD, MPH

People who hide illicit drugs can be classified in to three different types.

 

1.     Body stuffers – people who ingest drugs that are poorly wrapped to “eliminate” evidence from police – e.g. street dealers.

2.     Body packers – people who ingest large amounts of “well” packed drug packets to transport drugs (usually internationally) – aka “mule.”

3.     Body pushers – people hiding drugs in rectum or vagina.

 

Body stuffers are more frequently encountered in local ED compared to body packers. Stuffers can become symptomatic as the ingested drugs (cocaine, heroin, amphetamines) are often poorly wrapped (e.g. in plastic bag/wrap, cellophane paper, aluminium oil, etc.).

 

Recent retrospective article looked at the utility of 6-hour observation period in the ED as a management strategy for body stuffers. (n=126)

 

Characteristics

1.     Ingested drugs (self-reported): heroin (48%), cocaine (46%), other drugs [cannabis, MDMA, diazepam, methamphetamine] (16%), unknown (8%)

 

2.     Time of ingestion to ED presentation

  • < 2 hr: 58%
  • 2-6 hr: 10%
  • > 6 hr: 7%

 

Clinical findings

76% of the patients experience clinical signs of toxidrome at time of presentation.

Most common findings:

  • Hypertension: 30%
  • Tachycardia: 20%
  • Agitation: 16%

Patients who ingested heroin were more symptomatic vs. cocaine (87% vs. 70%)

 

Patients were discharged:

  • Within 6 hr: 72%
  • Between 6 – 12 hr: 10%
  • Between 12-24 hr: 10%
  • > 24 hr: 8%

 

Conclusion

  • Patients developed new or worsening drug toxicity within 6 hr of presentation
  • Majority of patients were discharged within 6 hr.
  • Asymptomatic patients at ED presentation should be observed for 6 hr.

References

Yamamoto T et al. Management of body stuffers presenting to the emergency department. Europ J Emerg Med. May 8 [Epub ahead of print] PDIM: 25969343