What is the treatment for a 2-year-old boy who ingested naphthalene balls?

Management of Naphthalene Ball Ingestion in a 2-Year-Old Child

Do NOT induce vomiting, perform gastric lavage, or administer activated charcoal due to the risk of aspiration and lack of benefit, as naphthalene is poorly absorbed from the gastrointestinal tract. 1, 2

Immediate Assessment and Monitoring

• Keep the child under observation for at least 6 hours even if asymptomatic, as naphthalene toxicity typically manifests 48-96 hours after exposure 2, 3
• Monitor vital signs closely, including continuous pulse oximetry (naphthalene can cause persistent readings of 84-85% despite oxygen supplementation) 3
• Assess for early signs of toxicity: fever, tachycardia, abdominal pain, vomiting, and dark brown urine 4, 3

Supportive Care (Primary Treatment)

The cornerstone of treatment is supportive care, as there is no specific antidote for naphthalene poisoning. 2, 3

• Provide intravenous fluid resuscitation to maintain adequate hydration and renal perfusion 4
• Monitor fluid and electrolyte balance carefully 2
• Ensure adequate oxygenation with supplemental oxygen as needed 3

Laboratory Monitoring

Obtain baseline and serial laboratory studies to detect complications:

• Complete blood count to monitor for hemolytic anemia (naphthalene causes acute intravascular hemolysis) 2, 4, 3
• Serum bilirubin (expect indirect hyperbilirubinemia) 3
• Methemoglobin levels (naphthalene causes methemoglobinemia) 5, 3
• Renal function tests (creatinine, BUN) to detect acute kidney injury 2, 4, 6
• Urinalysis for hemoglobinuria and proteinuria 4

Management of Specific Complications

Hemolytic Anemia

• Transfuse packed red blood cells if hemoglobin drops significantly or the child becomes symptomatic 5, 4, 3
• Administer ascorbic acid (vitamin C) to help reduce oxidative stress 5, 3
• Consider N-acetylcysteine as an antioxidant therapy 5, 3

Methemoglobinemia

• Administer intravenous methylene blue (1-2 mg/kg over 5 minutes) if methemoglobin levels are significantly elevated or the child is symptomatic 5, 3
• Note: Methylene blue may not be effective in all cases; if no improvement occurs after two doses, consider alternative therapies 5
• In severe refractory cases, plasmapheresis may be life-saving 5

Acute Kidney Injury

• Administer alkalis (sodium bicarbonate) in the presence of hemoglobinuria to prevent tubular damage 2
• Initiate hemodialysis or renal replacement therapy if acute kidney injury progresses despite conservative management 2, 5, 4

Critical Pitfalls to Avoid

• Do NOT induce emesis - this increases aspiration risk without benefit 2
• Do NOT perform gastric lavage - naphthalene is poorly absorbed from the GI tract, making decontamination ineffective and potentially harmful 2
• Do NOT administer activated charcoal unless specifically advised by poison control, as it provides no benefit and increases aspiration risk 1, 7, 2
• Do NOT delay treatment waiting for laboratory confirmation - begin supportive care immediately based on history of ingestion 1
• Do NOT discharge early - even asymptomatic children require minimum 6-hour observation, as serious complications develop 48-96 hours post-exposure 2, 3

Disposition

• Contact poison control center immediately for expert guidance on ongoing management 1
• Admit to hospital any child with confirmed naphthalene ingestion for monitoring, even if initially asymptomatic 2, 4
• Transfer to pediatric intensive care unit if hemolysis, methemoglobinemia, or acute kidney injury develops 2, 5

Prevention Counseling

• Educate parents about safe storage of mothballs away from children's reach 2
• Emphasize that even small amounts can cause serious toxicity in children, who are particularly vulnerable 2, 4