Methamphetamine toxicity secondary to intravaginal body stuffing.
BACKGROUND
People who ingest packets of illicit drugs or insert them into body cavities in an attempt to smuggle them are termed body packers. People who do this in an attempt to hide the drugs when encountered by law enforcement are called body stuffers. Severe toxicity and death occurs in body packers and body stuffers, and this is usually secondary to leaking of drug from packets in the gastrointestinal tract. This is well reported with cocaine and heroin and occurs less commonly with methamphetamine. We report an unusual case of intravaginal body stuffing that lead to severe methamphetamine toxicity in a young woman.


METHODS
A 20-year old female, who was in police custody, developed multiple seizures, altered mental status, tachycardia and hypertension shortly after admitting to having drugs enclosed in plastic bags in her vagina. She was hospitalized for 4 days with gradual improvement in her symptoms with the exception of a resting tachycardia. Gas chromatography and mass spectrometry of the urine at this time confirmed the presence of methamphetamine and the amphetamine metabolite, co-intoxicants were excluded based on comprehensive urine drug screening using GCMS. Quantitative serum levels of methamphetamine and amphetamine were 3100 ng/ml and 110 ng/ml, repectively.


CONCLUSIONS
We report an unusual case of intravaginal body stuffing that lead to severe methamphetamine toxicity in a young woman. This case highlights the potential for severe methamphetamine poisoning secondary to intravaginal stuffing. If either body packing or stuffing is suspected, a vaginal exam may be warranted.
Kashani
John
J
Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA. john.kashani@bannerhealth.com
Ruha
Anne-Michelle
AM
D000282:Administration, Intravaginal; D000328:Adult; D001831:Body Temperature / Q000187:drug effects; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D003415:Crime; D003422:Critical Care; D004632:Emergency Medical Services; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning*; D001523:Mental Disorders / Q000139:chemically induced / Q000523:psychology; D008694:Methamphetamine / Q000506:poisoning*; D007507:Therapeutic Irrigation
D000697:Central Nervous System Stimulants; D013287:Illicit Drugs; D008694:Methamphetamine