How to manage a case of suspected phenyl compound poisoning in a child or individual with accidental ingestion or substance abuse history?

Management of Phenyl Naphthalene Ball (Naphthalene) Poisoning

Immediately contact poison control center (1-800-222-1222 in the US) or emergency services while initiating treatment, as naphthalene poisoning requires urgent decontamination and supportive care. 1

Immediate Actions and Safety

• Remove all contaminated clothing and jewelry immediately to prevent continued absorption through skin contact 1, 2
• Healthcare workers must use appropriate personal protective equipment (gloves, protective clothing) when handling the patient or contaminated materials to prevent secondary exposure 2
• Do not induce vomiting - this is contraindicated and may worsen the condition 1, 2, 3
• Do not administer anything by mouth unless specifically advised by poison control center 1, 2

Route-Specific Decontamination

Dermal Exposure

• Immediately wash skin thoroughly with soap and water after removing contaminated clothing 1
• Polyethylene glycol (PEG) decontamination is preferred if available, followed by soap and water washing 1

Eye Exposure

• Flush eyes immediately with copious amounts of tepid water for at least 15 minutes if ocular exposure occurred 1, 2

Ingestion

• Do not administer alcohol or oral mineral oil as these may increase absorption of naphthalene 1
• Activated charcoal may be considered if advised by poison control center, but do not delay transportation to administer it 3, 4
• Olive oil administration via small bore nasogastric tube may be considered only if specifically advised by poison control 1

Emergency Department Referral Criteria

Refer immediately to emergency department if any of the following are present:

• Any suicidal intent, intentional abuse, or suspected malicious intent (child abuse/neglect) 5, 4
• Any symptoms beyond mild irritation, including:
  • Nausea, vomiting, or abdominal pain 3
  • Confusion, lethargy, or altered mental status 3, 4
  • Seizures or abnormal movements 2, 5
  • Hemolysis signs (dark urine, jaundice, pallor) - naphthalene is known to cause hemolytic anemia
  • Respiratory distress 2, 3
  • Any cardiovascular symptoms 3

Transportation Considerations

• Transportation via ambulance should be strongly considered based on patient condition, symptom severity, and time to reach emergency department 5, 4
• Standard BLS/ALS measures should be available during transport 6, 3

Supportive Care During Transport

For Seizures or Severe Agitation

• Administer benzodiazepines (diazepam first-line or midazolam) if seizures or severe agitation develop and authorized by EMS medical direction 2, 5, 4

For Respiratory Compromise

• Provide early endotracheal intubation if respiratory distress develops, consciousness is depressed, or hemodynamic instability occurs 2
• Standard respiratory support measures per BLS/ALS protocols 6, 3

For Cardiovascular Complications

• Treat hypotension and dysrhythmias according to standard ACLS protocols 2, 5

Critical Pitfalls to Avoid

• Never delay calling emergency services while awaiting patient response to interventions 6
• Never induce vomiting with ipecac syrup - this is obsolete and contraindicated 2, 3, 4
• Never delay treatment while waiting for confirmation of specific substance type - treat based on clinical presentation 2
• Never forget healthcare worker protection during decontamination - secondary exposure is a real risk 2
• Do not delay transportation to administer activated charcoal or other interventions 5, 4

Home Observation (Only if ALL criteria met)

Patients may be observed at home only if:

• No suicidal intent or malicious administration 5, 4
• Completely asymptomatic 3, 4
• Small, clearly defined exposure 5
• More than 4-6 hours have elapsed since exposure with no symptom development 4
• Poison control center specifically advises home observation 1, 3

Follow-up call should be made within 3-4 hours of initial contact to reassess symptom development 5, 4

Special Considerations for Naphthalene

Naphthalene (mothballs) specifically causes:

• Hemolytic anemia (especially in G6PD deficiency patients and infants)
• Methemoglobinemia in severe cases
• CNS depression and seizures
• Hepatotoxicity with prolonged exposure

These complications require hospital monitoring even with seemingly minor exposures in high-risk populations (infants, G6PD deficiency).