What is the treatment for camphor poisoning?

Treatment of Camphor Poisoning

Camphor poisoning requires immediate supportive care with aggressive seizure management using benzodiazepines, as there is no specific antidote available. 1

Immediate Emergency Response

• Contact poison control immediately (1-800-222-1222 in the US) while initiating treatment, as board-certified toxicologists can provide specialized guidance for camphor exposures 2, 3, 1
• Patients with seizures, lethargy, ataxia, or severe nausea/vomiting require immediate emergency department referral regardless of ingested amount 1
• Any ingestion exceeding 30 mg/kg mandates emergency department evaluation even in asymptomatic patients 1

Seizure Management (Primary Life-Threatening Complication)

• Administer benzodiazepines as first-line therapy for camphor-induced seizures, which typically manifest within minutes of exposure 1, 4
• Seizures may be severe, generalized tonic-clonic in nature, and can progress to respiratory depression requiring bag-valve-mask ventilation 5, 4
• Transport patients with active seizures via emergency medical services with benzodiazepine administration en route 1

Supportive Care (No Antidote Exists)

• Provide aggressive supportive care including airway management, respiratory support, and hemodynamic stabilization, as this is the only available treatment option 2, 6
• Administer 100% oxygen to maintain tissue oxygenation 7
• Monitor for and treat metabolic derangements including severe acidosis, electrolyte imbalances, and hyperglycemia 6, 4
• Anticipate potential complications: respiratory insufficiency, renal insufficiency, elevated hepatic enzymes, and leukocytosis 6, 4

Decontamination Strategies

What NOT to Do:

• Do NOT induce emesis with ipecac syrup in camphor ingestions due to rapid onset of seizures and aspiration risk 1
• Do NOT routinely administer activated charcoal for camphor alone, as it is not effectively adsorbed; consider only if co-ingestants are present that would benefit from charcoal 3, 1

Topical Exposure:

• Thoroughly wash skin with soap and water for dermal exposures and observe at home if asymptomatic 1
• Irrigate eyes copiously for at least 15 minutes with tepid water for ocular exposures 8, 1

Inhalation Exposure:

• Remove patient to fresh air environment and refer based on symptom severity; symptoms typically do not progress once removed from exposure 1

Observation Period and Disposition

• Asymptomatic patients who remain symptom-free for 4 hours can be safely observed at home 1
• Most patients recover within 24-48 hours, though be aware that persistent neurologic effects (delirium, memory loss, headache) can last up to 19 days in severe cases 6, 9
• Admit symptomatic patients to intensive care for monitoring and supportive management 6

Critical Pitfalls to Avoid

• Never underestimate small ingestions: even minimal amounts of concentrated camphor products (11-20% solutions still sold in some countries) can cause severe toxicity in children 5, 4
• Recognize delayed presentations: patients may present days after ingestion with persistent delirium or neurologic symptoms 9
• Screen for intentional self-harm or malicious administration, which requires immediate emergency department referral regardless of dose 1
• Be aware of illegally imported camphor products used in certain ethnic communities for spiritual purposes, cold remedies, or pest control—these often exceed legal concentration limits and lack proper labeling 4