You are on board a plane and mid way through the flight. A person sitting near you became excited, restless, very talkative and maniacal following this he became very dull and pale. On examination his pupils were dilated and his body temperature elevated. On fuher examination he had ulceration of the nasal septum also. He later had convulsion. The onboard emergency kit with glucometer relieved his blood sugar to be 150 mg/dl. He also had arrhythmia. Despite resuscitative and suppoive measures he died before the plane landed. What is your diagnosis?
This is a case of body stuffer syndrome. Here the illegal drugs are packed in plastic bags and swallowed. Occasionally the bags burst in to GIT leading to massive absorption of the drug (most likely cocaine in this case) resulting in toxicity and death. The nasal septal ulcer provides the clue that he may be a cocaine user. The low pressure in the plane may also have contributed to the bursting of the plastic bag. Ref: The Essentials of Forensic Medicine and Toxicology by Narayana Reddy, Edition 21, Page 525 to 530
Body stuffer syndrome
Acute Dystonia
Delirium tremens
Meningitis