Body packing and stuffing First detected case in Lithuania

• A 31 year old male was brought to the Department of Toxicology by customs officers after disembarking at the Vilnius International Airport suspecting of cocaine transport

Body packing and stuffing First detected case in Lithuania

• There were no any complaints and examination of patient didn’t show any pathology

• All blood tests were normal• Patient refused endoscopy, but agree to

contrast X- ray investigation• Foreign bodies were detected in the

gastrointestinal tract by X-ray photography• Toxicological analysis for narcotics of urine and

blood were done

Body packing and stuffing First detected case in Lithuania

• Observation (blood pressure, heart frequency, temperature, neurological assessment every hour)

• Mild laxative in conjunction with sufficient beverages

Body packing and stuffing First detected case in Lithuania

“double condom’’ signFill defects

Body packing and stuffing First detected case in Lithuania

39 packets were excreted on the first day, 10 – on the second day, 3 – at the third day

X-ray 3 days later revealed foreign bodies in the gastrointestinal tract (“double condom’’ sign)

Because of customs officers demand the patient was transferred to the Hospital of Prison, despite staff objection. 62 cocaine packets were excreted during the next 3 days

Body packing and stuffing First detected case in Lithuania

• Condoms were filled with 3-8 g of cocaine each

• 114 packages, weight 438,63 g,purity – 57%

• 2 of cocaine packets were slightly injured

• Blood sample – no answer, urine analysis – “possibility of cocaine metabolites”

Forensic analysis

Body packing and stuffing First detected case in Lithuania

• Offer of gastroscopy

• No express test (urine or blood)

• Removing from ICU settings to the Hospital of Prison without any emergency support, according to the patient’s claim and officers demand

Our mistakes

Body packing and stuffing Management

•In no way endoscopic removal of the package should be attempted. The patient in whom only one packet fails to pass the pylorus may be the exception•Conservative management during spontaneous evacuation of the containers is the first choice approach to the body-packing•Surgery is indicated for patients with acute cocaine poisoning or gastrointestinal obstruction or perforation•Observation till the last package removes is obligatory

AmphetamineNeurochemical actions

• Dose-related increase in release of norepinephrine, dopamine and serotonin:– low dose: preferential action on NE release– moderate dose: NE and DA release– high dose: NE, DA and serotonin release

• Blockade of reuptake of NE, DA and serotonin• Inhibition of MAO

AmphetamineSymptoms

• Agitation to psychosis• Halucinations• Mydriasis• Tachycardia • Hypertension • Mild hypertermia• Seizures• Coma

AmphetamineTreatment

• No antidotes• CPR• GI decontamination gastric lavage, activated charcoal• Benzodiazepines• Severe hypertension phentolamin, nitropruside• External cooling• SVT Ca antagonists

VT lidocaine• No β-blockers

“Ecstasy” (MDMA): a hallucinogenic amphetamine

• Combination of psychostimulant effects with stronger hallucinogenic effects (serotonin component)

• Common acute adverse effects: muscle tension and bruxism

• Hyperthermia• Increase HR and BP• Acne-like rash

CannabinoidsSymptoms

http://drugabuse.gov

CannabinoidsSymptoms

• Impairment of cognitive function • Disorientation, talkativness• Anxiety to panic• Headache• “Exploding chest”• Sedation

• Ataxia• Tremor• Dry mouth• Tachycardia• Injected

conjunctive

CannabinoidsTreatment

• Benzodiazepines

• Symptomic treatment

• Psychoterapy

LSD Symptoms

• Anxiety, agitation

• Hallucinations

• Moist and pale skin

• Mild hypertension

• Tachycardia

• Hypertermia

(Lysergic Acid Diethylamine)

LSD Treatment

• Benzodiazepines

• In severe cases – the same as amphetamines

(Lysergic Acid Diethylamine)

Gamma-hydroxybutyric acid Symptoms

• CNS depression (GCS of 3 is not uncommon)• Extreme combativeness and

agitation• Bradycardia • Decreased systemic vascular

resistance, hypotension• Profound respiratory depression.

Gamma-hydroxybutyric acid Treatment

• Airway protection and aspiration precautions

• Use atropine to treat symptomatic bradycardia that is unresponsive to stimulation

Solvents Symptoms

• Agitation, joy• Vertigo, coordination damamge • Sneeze, hypersalivation• CNS depression, delusions • Sense of invulnerability • Respiratory depression • Tachycardia• Seizures, coma

Solvents Treatment

• Oxygen• CPR (if needed)

• Benzodiazepines

• Symptomic treatment

Milestones in treatment of drug overdose

Naloxone

Benzodiazepines

Life support measures