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©2013 UpToDate ® Print Email Internal concealment of drugs of abuse (body packing) To obtain emergent consultation with a medical toxicologist, call the United States Poison Control Network at 1-800-222-1222, or access the World Health Organization's list of international poison centers ( www.who.int/gho/phe/chemical_safety/poisons_centres/en/index.html ). History Inquire about type of drug, method of wrapping, number of packets Physical exam Assess for heroin toxicity Depressed mental status, decreased respirations, pinpoint pupils, absent bowel sounds Assess for cocaine toxicity Agitation, hypertension, tachycardia, seizures, cardiac dysrhythmias Assess for evidence of packets on physical examination (abdominal and rectal exams) Assess for evidence of gastrointestinal obstruction or perforation (distension, tenderness) Diagnosis A plain abdominal radiograph is the best screening study If suspicion is high but plain radiograph is negative, CT (or barium enhanced abdominal radiography) should be performed Urinalysis lacks sensitivity as a screening test, but may identify packet content(s) Treatment Asymptomatic Whole bowel irrigation (polyethylene glycol electrolyte lavage solution), 2 L/h plus promotility agent (erythromycin 500 mg IV, or metoclopramide 10 mg IV) Gastrointestinal obstruction or perforation Surgical decontamination Evidence of heroin toxicity Naloxone (high doses may be required: eg, 2 to 5 mg IV, may be given every 5 minutes until patient responsive) Whole bowel irrigation, 2 L/h plus promotility agent Evidence of cocaine toxicity Benzodiazepines (eg, midazolam 1 to 2 mg IV, may be repeated); aggressive supportive care Surgical decontamination Endpoint of therapy Contrast-enhanced abdominal CT (or barium-enhanced radiography) to document clearance of all packets from the GI tract