Management of Pediatric Camphor Ingestion
Children who have ingested more than 30 mg/kg of camphor or who exhibit any symptoms of toxicity (seizures, lethargy, ataxia, severe nausea/vomiting) should be referred immediately to an emergency department for observation and treatment. 1
Immediate Triage and Referral Decisions
High-Risk Patients Requiring Immediate ED Referral
- Any child with suspected self-harm or malicious administration must be referred to an emergency department immediately, regardless of amount ingested 1
- Ingestion of ≥30 mg/kg camphor requires ED referral 1
- Any symptomatic child exhibiting moderate to severe toxicity (convulsions, lethargy, ataxia, severe nausea/vomiting) by any route of exposure requires ED referral 1
- Children under 6 years who ingested ≥500 mg require rapid triage to the closest healthcare facility, as this dose has been associated with mortality 2
Critical Dosing Context
- Products containing 10% camphor deliver 500 mg in just 5 mL 2
- Doses of 750-1000 mg are commonly associated with seizures and death in children 2
- Camphorated oil preparations in Canada contain up to 20% concentration, making even smaller volumes highly dangerous 3
- Seizures can occur as early as 5 minutes after exposure 4
Pre-Hospital Management
Seizure Management During Transport
- If convulsions occur, transport by EMS to ED immediately 1
- Administer benzodiazepines to control seizures 1, 4
- Maintain airway protection, as respiratory depression can follow seizures 3
Decontamination: What NOT to Do
- Do NOT induce emesis with ipecac syrup 1
- Do NOT administer activated charcoal for camphor ingestion alone (it is ineffective for camphor) 1
- Activated charcoal may be considered only if co-ingested substances are present that would benefit from charcoal adsorption 1
Home Observation Criteria
Asymptomatic children who remain symptom-free for 4 hours after exposure can be safely observed at home 1
This recommendation applies only to:
- Children who ingested less than 30 mg/kg 1
- Children with no symptoms at any point during the 4-hour observation period 1
- Exposures that are clearly accidental (not self-harm or malicious) 1
Route-Specific Management
Topical Exposures
- Wash skin thoroughly with soap and water 1
- Observe at home for symptom development 1
- Refer to ED only if symptoms develop 1
Eye Exposures
- Irrigate eyes according to standard poison center protocols 1
- Referral based on presence and severity of symptoms 1
Inhalation Exposures
- Move patient to fresh air environment immediately 1
- Refer for medical care based on symptom presence and severity 1
- Symptoms are unlikely to progress once removed from exposure environment 1
Emergency Department Management
Initial Assessment and Stabilization
- Assess and secure airway - intubation may be required if mental status deteriorates 4
- Administer IV benzodiazepines for seizure control 4
- Obtain ECG to monitor for QRS widening and QT prolongation 4
- Establish IV access and administer fluids 4
Monitoring Parameters
- Mental status - confusion, agitation, and restlessness are common early signs 4
- Neurological status - anticipate seizures, which can recur 4
- Cardiac monitoring - watch for arrhythmias and conduction abnormalities 4
- Respiratory status - respiratory depression can follow seizures 3
Disposition
- Symptomatic patients require ICU admission for close monitoring 4
- Treatment is primarily supportive with focus on seizure control and respiratory support 3, 4
- Most patients can be extubated within 48 hours if intubation was required 4
Critical Pitfalls to Avoid
- Do not underestimate small volumes - as little as 5 mL of 10% camphor products contains a potentially lethal dose for young children 2
- Do not delay ED referral for symptomatic children or those meeting dose thresholds 1
- Do not attempt gastric decontamination with ipecac or activated charcoal 1
- Do not assume safety based on product availability - over-the-counter status does not indicate safety in overdose 3, 4