Toxicokinetics of cocaine and metabolites in a body-packer becoming symptomatic.

Life-threatening complications may occur in body-packers and the rupture of a single packet containing cocaine may lead to fatality. We report the case of a 35-year-old body-packer who developed at the airport clinical signs of cocaine toxicity. There was evidence of bowel obstruction. The plasma concentration of cocaine, benzoylecgonine (BZE) and ecgonine methyl ester (EME) was determined 1 h after symptoms onset, during surgery and postoperative period. The measured peak value at 1 h was 594 ng/ml for cocaine, 9423 ng/ml for BZE and 3261 ng/ml for EME. We confirm the following order BZE > EME > cocaine for peak plasma concentrations. A rebound in plasma levels was found during surgery, together with electrocardiographic changes. A total of 107 packets were eliminated, and the patient survived.