What is the treatment for naphthalene (mothball) poisoning?

From the Guidelines

Treatment for naphthalene (mothball) poisoning primarily involves supportive care as there is no specific antidote. Immediate removal from exposure is essential, followed by decontamination if ingestion occurred recently. Medical professionals may administer activated charcoal within one hour of ingestion to reduce absorption, as suggested by general principles of poisoning management 1. Supportive measures include oxygen therapy for respiratory distress, intravenous fluids for hydration, and monitoring of vital signs. Blood transfusions may be necessary for severe hemolytic anemia, which is a common complication due to naphthalene's oxidative damage to red blood cells. Methylene blue (1-2 mg/kg IV) might be used for methemoglobinemia if levels exceed 30% or if the patient is symptomatic. Exchange transfusion could be required in severe cases, particularly in infants. Monitoring liver and kidney function is important as naphthalene can cause organ damage. Patients should be observed for at least 24 hours since symptoms may develop gradually, with particular attention to hemolysis which can occur up to 2-4 days after exposure. Prevention of future exposure through education about the dangers of mothballs is crucial for long-term management.

Some key considerations in the management of naphthalene poisoning include:

• Immediate removal from the source of exposure
• Decontamination if ingestion occurred recently
• Administration of activated charcoal to reduce absorption
• Supportive care including oxygen therapy, intravenous fluids, and monitoring of vital signs
• Potential need for blood transfusions or exchange transfusion in severe cases
• Monitoring for organ damage, particularly to the liver and kidneys
• Observation for at least 24 hours with attention to potential delayed onset of symptoms

It's also important to note that while specific antidotes may not be available for naphthalene poisoning, the general principles of managing poisoning, including prevention of further exposure, supportive care, and in some cases, the use of extracorporeal therapies, are crucial 1. Additionally, consultation with a medical toxicologist or a certified regional poison center can provide valuable guidance in the management of such cases 1.

From the Research

Treatment Overview

The treatment for naphthalene (mothball) poisoning typically involves a combination of supportive care and specific interventions to address the resulting complications, such as hemolysis, methemoglobinemia, and acute kidney injury.

• Supportive treatment may include:
  • Intravenous fluids
  • Blood transfusions
  • Adequate hydration
• Specific interventions may include:
  • Administration of intravenous methylene blue, N-acetylcysteine, and ascorbic acid 2, 3, 4
  • Renal replacement therapy, such as hemodialysis or continuous venovenous haemofiltration, for acute kidney injury 2, 3, 4
  • Plasmapheresis in severe cases of methemoglobinemia 2

Management of Complications

The management of naphthalene poisoning complications is crucial for a favorable outcome.

• Hemolysis and methemoglobinemia can be managed with blood transfusions and specific interventions, such as methylene blue administration 2, 3, 4
• Acute kidney injury can be managed with renal replacement therapy, such as hemodialysis or continuous venovenous haemofiltration 2, 3, 4
• Early diagnosis and intervention are critical for preventing long-term damage and improving outcomes 5

Patient Monitoring and Follow-up

Close monitoring and follow-up are essential for patients with naphthalene poisoning.

• Patients should be monitored for signs of hemolysis, methemoglobinemia, and acute kidney injury 2, 6, 3, 5, 4
• Regular laboratory tests, such as complete blood counts and serum creatinine levels, should be performed to assess the patient's condition 2, 6, 3, 5, 4
• Outpatient follow-up and haemodialysis may be necessary for some patients 3