Takahiro Yamamoto1, Elisa Malavasi, John R H Archer, Paul I Dargan, David M Wood. 1. aClinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners bKing's College London, London, UK cPoison Control Center Bergamo, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Abstract
OBJECTIVE: The aim of this study was to establish a management protocol for body stuffers presenting to the emergency department. METHODS: This is a retrospective observational case series of patients presenting to the emergency department of a large inner-city hospital as 'body stuffers' during the period between 1 January 2006 and 31 October 2011, irrespective of the type of drug ingested. We reviewed demographic data, ingestion characteristics, clinical progress and outcome. RESULTS: A total of 126 patients were included in the study, with a mean age of 31±8.10 years (range 15-58 years), among whom 106 were male (84%). Drugs ingested were as follows: heroin (n=61, 48%), cocaine (n=58, 46%), other drugs (n=20, 16%) and unknown (n=10, 8%). Of the patients, 23 (18%) ingested more than one drug. At presentation, 96 had features of drug toxicity. The presence of depressant drug toxidrome was more commonly observed among heroin users, but stimulant drug toxidromes were seen across all groups. Of the patients, 12 developed changes in clinical state, with a mean time to development of symptoms of 2 h 50 min±1 h 39 min (range from 1 h 0 min to 5 h 36 min). Abdominal radiography showed the presence of foreign bodies in 8% of the tests performed, and packets were recovered from one patient who underwent gut decontamination. CONCLUSION: Patients developed new or worsening features of drug toxicity within 6 h of presentation. Toxidromes observed are often not drug/class specific, and treatment including gut decontamination and radiography do not aid in expediting discharge. We propose an observation period of 6 h from the time of admission as the time required if the patient is asymptomatic or there is resolution of presenting signs and symptoms.
OBJECTIVE: The aim of this study was to establish a management protocol for body stuffers presenting to the emergency department. METHODS: This is a retrospective observational case series of patients presenting to the emergency department of a large inner-city hospital as 'body stuffers' during the period between 1 January 2006 and 31 October 2011, irrespective of the type of drug ingested. We reviewed demographic data, ingestion characteristics, clinical progress and outcome. RESULTS: A total of 126 patients were included in the study, with a mean age of 31±8.10 years (range 15-58 years), among whom 106 were male (84%). Drugs ingested were as follows: heroin (n=61, 48%), cocaine (n=58, 46%), other drugs (n=20, 16%) and unknown (n=10, 8%). Of the patients, 23 (18%) ingested more than one drug. At presentation, 96 had features of drug toxicity. The presence of depressant drug toxidrome was more commonly observed among heroin users, but stimulant drug toxidromes were seen across all groups. Of the patients, 12 developed changes in clinical state, with a mean time to development of symptoms of 2 h 50 min±1 h 39 min (range from 1 h 0 min to 5 h 36 min). Abdominal radiography showed the presence of foreign bodies in 8% of the tests performed, and packets were recovered from one patient who underwent gut decontamination. CONCLUSION:Patients developed new or worsening features of drug toxicity within 6 h of presentation. Toxidromes observed are often not drug/class specific, and treatment including gut decontamination and radiography do not aid in expediting discharge. We propose an observation period of 6 h from the time of admission as the time required if the patient is asymptomatic or there is resolution of presenting signs and symptoms.