What is the treatment for a patient with camphor poisoning?

Treatment of Camphor Poisoning

Camphor poisoning requires immediate aggressive supportive care with airway management, respiratory support, and hemodynamic stabilization, as there is no specific antidote available. 1, 2

Immediate Emergency Response

• Contact poison control center immediately (1-800-222-1222 in the United States) while initiating treatment, as board-certified toxicologists can provide specialized guidance for camphor exposures 1, 3
• Do not delay treatment while waiting for confirmatory testing—treat based on clinical presentation and exposure history 4

Supportive Care (Primary Treatment)

Supportive care is the only available treatment option for camphor poisoning, as no antidote exists 1, 2

Airway and Respiratory Management

• Establish and maintain airway patency with endotracheal intubation if mental status deteriorates or seizures occur 5
• Administer 100% oxygen to maintain tissue oxygenation 1
• Provide mechanical ventilation support as needed for respiratory insufficiency 2

Hemodynamic Support

• Monitor cardiovascular status continuously, paying special attention to QRS complex widening on ECG 5
• Provide intravenous fluid resuscitation for hemodynamic stabilization 1, 5
• Correct electrolyte imbalances and metabolic acidosis aggressively 2

Seizure Management

Administer benzodiazepines (diazepam or midazolam) as first-line therapy for seizures, which can occur as early as 5 minutes after exposure 6, 5, 4

• Benzodiazepines should be given intravenously for rapid control of convulsions 6
• Anticipate seizures in all symptomatic patients, as generalized tonic-clonic seizures are the most prominent manifestation 5

Decontamination Strategies

Dermal Exposure

• Remove all contaminated clothing and jewelry immediately to prevent continued absorption 4
• Thoroughly wash exposed skin with soap and water 6, 4
• Healthcare providers must use appropriate personal protective equipment to prevent secondary contamination 4

Ocular Exposure

• Irrigate eyes copiously with tepid water for at least 15 minutes 1, 6

Ingestion

• Do NOT induce vomiting with ipecac syrup 6
• Do NOT routinely administer activated charcoal for camphor ingestion alone, as its benefit is uncertain 6, 4
• Activated charcoal may be considered only if co-ingested substances are present that would benefit from charcoal adsorption 6

Triage and Referral Guidelines

Immediate Emergency Department Referral Required:

• Any ingestion >30 mg/kg of camphor 6, 7
• Patients exhibiting moderate to severe symptoms (convulsions, lethargy, ataxia, severe nausea/vomiting) by any route 6
• All cases of stated or suspected self-harm or malicious administration 6
• Patients with seizures should be transported by pre-hospital emergency medical services 6

Home Observation Acceptable:

• Asymptomatic patients with ingestions <10 mg/kg 7
• Patients who remain asymptomatic after 4 hours of observation can be safely observed at home 6

Monitoring Requirements

• Observe patients for at least 48-72 hours, even if initially stable, due to risk of delayed effects 4
• Monitor for persistent neurological effects including confusion, delirium, and memory loss, which may extend beyond the typical 24-48 hour window 8, 2
• Continuously monitor hepatic enzymes, renal function, and cardiac rhythm 2, 5

Critical Pitfalls to Avoid

• Never delay treatment while awaiting laboratory confirmation—treat based on clinical presentation 4
• Avoid neuromuscular blockers without adequate sedation if intubation is required, as they mask seizure activity without treating it 4
• Do not underestimate the duration of toxic effects—symptoms may persist for 19 days or longer in severe cases 8
• Do not assume resolution after 24-48 hours, as physiologic derangement may persist far longer 8