The authors described a case of emergency department of presentation of acute cocaine delirium in a cocaine "body packer," ie, an individual who attempted to smuggle cocaine by intracorporeal means. Treatment for cocaine intoxication was not initiated because of patient gave a false history; did not present with seizures, stupor or coma; had no deterioration in vital signs until late in the presentation; and presented with apparent psychiatric symptomatology, ie, delirium. Delirium should be treated by first identifying its cause and by attempting to remove the cause by appropriate medical and surgical techniques.