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Three Part Question

In [currently asymptomatic patients who have swallowed packets of methamphetamine] what [clinical parameters] are useful in [predicting outcome and complications]?

Clinical Scenario

A 20-year-old man presents to the emergency department with police officers after he was witnessed swallowing a bag of methamphetamine. He denies ingestion of any other substances and has no specific complaints at this time. The time of ingestion is 30 min before evaluation. His vital signs are: blood pressure 134/86, pulse 94, heart rate 18, temperature 37.6°. You wonder whether to attempt actively to expedite the passage of the toxin or if conservative management is acceptable.

Search Strategy

Ovid MEDLINE(R) 1946 to February week 1 2013: (exp Methamphetamine/OR exp Amphetamine-Related Disorders/) AND (exp foreign bodies OR body stuffers.mp. OR body packers.mp. OR body pushers.mp)
Embase via NHS evidence 1980 to February 16 2013: ((exp METHAMPHETAMINE/ OR exp METHAMPHETAMINE DEPENDENCE/) AND ((exp FOREIGN BODY/) OR ((body AND stuffer).ti,ab) OR ((body AND packer).ti,ab) OR ((body AND pusher).ti,ab))) (Limit to: English Language).

The Cochrane Database of Systematic Reviews Issue 1 of 12 2013 ‘methamphetamine’ in title abstract keywords.

Search Outcome

Eleven papers were identified, one study was relevant to the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
West et al, 2010, USA	648 Patients were identified as methamphetamine exposures by a query of the Oregon Poison Centre database from January 2001 to July 2007. Two toxicologists identified 55 patients as body stuffers. These patients had chart review with data extraction. An outcome-based stratification of patients was performed. Definitions of a ‘severe outcome’ and a ‘benign outcome’ were determined before data analysis	Retrospective case series	Presenting Heart Rate	Severe: 148; Benign: 106	There are several limitations to this study. First, this is a non-concurrent case series, Second, the study examines a single poison centre\\\'s data. This study also has a selection bias in that it includes only cases that were called in to the poison centre
			Presending Systolic BP	Severe: 146; Benign: 140
			Presenting Temperature	Severe: 38.8; Benign: 36.6
			Median Amount Ingested	Severe: 3.5g; Benign: 3.0g

Comment(s)

The patient described in the clinical scenario above has stable presenting vital signs and otherwise appears well. The current literature suggests that he is likely to have a benign outcome and probably does not need active decontamination measures such as whole bowel irrigation. However, it should be noted that there is only one study that addresses this subject and more research is needed in this area.

Clinical Bottom Line

A greater likelihood of severe outcomes can be anticipated if the presenting pulse is greater than 120 or the presenting temperature is greater than 38°C. More research is required to establish clinical guidelines for the management of methamphetamine body stuffers.

References

1. West P, McKeown N, Hendrickson R Methamphetamine Body Stuffers: An Observational Case Series Ann Emerg Med 2010;55:190–7.