What is the management for accidental camphor (C10H16O) ingestion?

Management of Accidental Camphor Ingestion

In cases of accidental camphor ingestion, patients who have ingested more than 30 mg/kg or who exhibit symptoms of moderate to severe toxicity should be immediately referred to an emergency department for observation and treatment. 1

Initial Assessment and Triage

• Contact Poison Control Center (800-222-1222 in the US) immediately to evaluate the systemic toxicity of camphor and receive specific guidance on management 2
• Determine the amount ingested, time of ingestion, and presence of symptoms 1
• Assess for signs of toxicity, which can develop rapidly (within minutes) and include:
  • Neurological: seizures, lethargy, ataxia, confusion, agitation 1, 3
  • Gastrointestinal: severe nausea and vomiting 1
  • Respiratory: respiratory depression 4
  • Cardiovascular: cardiac arrhythmias 3

Emergency Management

For Symptomatic Patients

• Ensure airway patency and provide respiratory support if needed 3
• Control seizures with benzodiazepines as first-line treatment 1, 3
• Monitor cardiac function with ECG for potential arrhythmias and QT/QRS abnormalities 3
• Provide supportive care with IV fluids 3
• Do not induce emesis with ipecac syrup as this is contraindicated in camphor poisoning 1
• Do not administer activated charcoal unless advised by poison control center, as it has not been shown to be effective for camphor ingestion 2, 1
• Do not administer water or milk as dilution has not been proven beneficial and may cause emesis and aspiration 2

For Asymptomatic Patients

• Observe for at least 4 hours after ingestion, as symptoms can develop rapidly 1
• If the patient remains asymptomatic after 4 hours, they can be safely observed at home 1
• Provide clear instructions to return immediately if any symptoms develop 1

Special Considerations

• Camphor toxicity can cause severe acidosis, electrolyte imbalances, and elevated hepatic enzymes requiring intensive monitoring 5
• Symptoms typically resolve within 24-48 hours, but in some cases, effects may persist for much longer (up to 19 days has been reported) 6
• Patients with severe poisoning may require ICU admission and intubation for respiratory support 3
• Memory loss and cognitive impairment can occur as sequelae of camphor poisoning 5

Prevention

• Educate patients and caregivers about the dangers of camphor-containing products 4
• Emphasize proper storage of camphor products away from children 4
• Clarify that camphor is for external use only and should never be ingested 3

Common Pitfalls to Avoid

• Underestimating the toxicity of camphor - even small amounts can cause serious poisoning, especially in children 4
• Assuming symptoms will not progress once the initial presentation is mild - seizures can occur suddenly even after a period of minimal symptoms 1
• Discharging patients too early - observation for at least 4 hours is necessary even in asymptomatic cases 1
• Failing to recognize that neurological effects may persist long after other symptoms have resolved 6