Ver el código de «Body packing»

<languages/>
<translate>

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

<!--T:2-->
[[File:Blausen 0817 SmallIntestine Anatomy.png|thumb|Small bowel anatomy with surrounding structures.]]
[[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
*Packets usually made of several layers of latex and outer wax coating
*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
*Distinct from [[Special:MyLanguage/Body stuffing|Body stuffing]] (ingestion of illicit drugs while pursued by law enforcement, usually small quantity)

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


==Clinical Features== <!--T:3-->

<!--T:4-->
*Situations in which body packers present to the ED:
**Asymptomatic but in custody 
**Signs of [[Special:MyLanguage/toxidromes|toxidromes]] from a ruptured packet
**Signs of [[Special:MyLanguage/bowel obstruction|bowel obstruction]] or perforation
*History and physical
**Type of drug
**Type of packet wrapping (more likely to rupture or leak if home made)
**Number of packets ingested
**GI symptoms ([[Special:MyLanguage/abdominal pain|pain]], distention, obstipation)
**Other drug use 


==Differential Diagnosis== <!--T:5-->

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


==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: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
*[[Special:MyLanguage/Urine drug screen|Urine drug screen]]: may be misleading


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

<!--T:9-->
*Asymptomatic patients
**Expectant management, no surgery, close monitoring in ICU until passage of all packets
**[[Special:MyLanguage/Whole bowel irrigation|Whole bowel irrigation]] with polyethylene glycol via NGT at 2L per hour
**[[Special:MyLanguage/Activated charcoal|Activated charcoal]] more useful in body stuffers
*[[Special:MyLanguage/Opioid toxicity|Opioid toxicity]]
**[[Special:MyLanguage/Naloxone|Naloxone]]: may require very high doses 
***2 to 5mg IV initially, repeat 2mg q5min until responsive
***then total amount required for response should be given every hour as continuous drip
*[[Special:MyLanguage/Sympathomimetic toxicity|Sympathomimetic toxicity]]
**Immediate OR for surgical decontamination
**No place for conservative management
**Pharmacologic stabilization appropriate but not definitive, do not delay transfer to the OR
***[[Special:MyLanguage/Hyperthermia|Hyperthermia]]
****Active external cooling
****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)
***[[Special:MyLanguage/Hypertension|Hypertension]]
****IV [[Special:MyLanguage/benzodiazepines|benzodiazepines]],  [[Special:MyLanguage/phentolamine|phentolamine]], [[Special:MyLanguage/nitroprusside|nitroprusside]], [[Special:MyLanguage/nitroglycerin|nitroglycerin]],, or [[Special:MyLanguage/nicardipine|nicardipine]]
***[[Special:MyLanguage/Seizures|Seizures]]
****IV [[Special:MyLanguage/benzodiazepines|benzodiazepines]], followed by [[Special:MyLanguage/propofol|propofol]] if needed
***[[Special:MyLanguage/Ventricular dysrhythmias|Ventricular dysrhythmias]]
****IV [[Special:MyLanguage/benzodiazepines|benzodiazepines]], followed by hypertonic [[Special:MyLanguage/sodium bicarbonate|sodium bicarbonate]] if wide QRS
*[[Special:MyLanguage/bowel obstruction|Obstruction]] or perforation
**OR for immediate ex-lap, then advanced imaging study to document a clear GI tract
**Endoscopic removal highly controversial, risk of packet perforation


==Disposition== <!--T:10-->

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


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

<!--T:13-->
*[[Special:MyLanguage/Body stuffing|Body stuffing]]
*[[Special:MyLanguage/Drugs of abuse|Drugs of abuse]]
*[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]]
*[[Special:MyLanguage/Rectal foreign body|Rectal foreign body]]


==External Links== <!--T:14-->


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

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

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