What is the treatment protocol for a patient with suspected camphor poisoning?

Management of Camphor Ingestion

Immediate Triage and Emergency Department Referral

Patients who have ingested more than 30 mg/kg of camphor or who exhibit any symptoms of moderate to severe toxicity (convulsions, lethargy, ataxia, severe nausea and vomiting) must be referred to an emergency department immediately for observation and treatment. 1

• Patients with stated or suspected self-harm or malicious administration should be referred to an emergency department immediately, regardless of the amount ingested 1
• Activate emergency medical services (EMS) immediately if the patient exhibits any life-threatening symptoms including sleepiness, seizures, difficulty breathing, or vomiting 2
• Contact the Poison Help hotline (800-222-1222) for specific guidance on camphor toxicity management 2

Clinical Presentation and Timing

• Camphor toxicity manifests extremely rapidly, typically within 5-15 minutes of ingestion 3
• Common manifestations include confusion, restlessness, delirium, hallucinations, muscle twitching, myoclonus, ataxia, hyperreflexia, fasciculations, and seizures 3
• Severe poisoning can result in seizures, apnea, coma, renal insufficiency, raised hepatic enzyme levels, and aspiration pneumonitis from vomiting 4
• Asymptomatic patients who remain symptom-free after 4 hours of observation can be safely observed at home 1
• Be aware that toxic effects may persist far beyond the typical 24-48 hour window in some cases, with documented cases showing persistent delirium and cognitive effects up to 19 days post-ingestion 5

Decontamination: What NOT to Do

Do not induce emesis with ipecac syrup in patients who have ingested camphor products 1

• Ipecac administration is contraindicated and provides no clinical benefit while potentially causing harm through aspiration 2, 1
• Do not administer activated charcoal for camphor ingestion alone 1
• Activated charcoal has not been shown to be effective for camphor poisoning and should only be considered if there are other co-ingested substances that are effectively adsorbed by activated charcoal 1
• Do not perform gastric lavage unless specifically directed by poison control, as it increases aspiration risk 3
• Do not administer anything by mouth (including water or milk for dilution) unless advised by poison control or emergency medical personnel, as this may cause emesis and aspiration 2

Seizure Management

Patients exhibiting convulsions following camphor exposure should be transported to an emergency department by pre-hospital emergency medical care providers, and a benzodiazepine should be used to control seizures 1

• Seizures are the most common and serious complication of camphor toxicity 3
• Benzodiazepines are the first-line treatment for camphor-induced seizures 1

Supportive Care

There is no antidote available for camphor poisoning; treatment is entirely supportive 4, 3

• Provide aggressive supportive care including airway management and respiratory support 4
• Monitor for respiratory insufficiency and be prepared for early intubation and mechanical ventilation in patients with severe respiratory distress or central nervous system involvement 3
• Monitor electrolyte balance, renal function (creatinine), hepatic enzymes, and amylase levels 4
• Provide careful fluid balance monitoring 3
• Transfer to intensive care unit for severe cases with altered mental status, severe acidosis, or respiratory compromise 4

Topical and Inhalation Exposures

• For asymptomatic patients with topical exposures, thoroughly wash the skin with soap and water and observe at home for development of symptoms 1
• For eye splash exposures, irrigate the eyes according to standard poison center procedures and refer based on presence and severity of symptoms 1
• For inhalation exposures, move the patient to fresh air and refer for medical care based on presence and severity of symptoms; symptoms are unlikely to progress once removed from the exposure environment 1

Common Pitfalls to Avoid

• Do not assume resolution of symptoms within 24-48 hours; persistent cognitive effects and delirium can occur for weeks in severe cases 5
• Do not underestimate small ingestions; even small doses of camphor can cause serious toxicity and are potentially fatal 3
• Do not use prophylactic antibiotics or corticosteroids, as there is no clear benefit 3
• Do not discharge asymptomatic patients before completing a minimum 4-hour observation period 1