What is the appropriate management for a patient who has ingested paradichlorobenzene (p‑dichlorobenzene)?

Management of Paradichlorobenzene Ingestion

For paradichlorobenzene ingestion, prioritize supportive care with airway management, hemodynamic monitoring, and correction of metabolic derangements while immediately contacting poison control (1-800-222-1222 in the US) for expert guidance, as no specific antidote exists and gastrointestinal decontamination is generally not indicated. 1

Immediate Stabilization

Supportive care takes absolute priority over identification of the specific toxicant. 1

• Secure the airway and provide respiratory support if needed, as this is the foundation of poisoning management 1
• Monitor vital signs continuously, including blood pressure, heart rate, and oxygen saturation 1
• Establish IV access for fluid resuscitation and medication administration if clinically indicated 1
• Correct any critical metabolic derangements (hypotension, dysrhythmias, hypoxia) using standard resuscitation protocols 1

Gastrointestinal Decontamination Considerations

Do not perform gastric lavage for paradichlorobenzene ingestion. 2

• Gastric lavage is contraindicated due to lack of proven benefit and significant risks including aspiration pneumonia, dysrhythmias, and esophageal perforation 2
• Activated charcoal may be considered only if the patient presents within 1-2 hours of ingestion and has a protected airway, though evidence for benefit with paradichlorobenzene specifically is limited 2, 3
• The standard activated charcoal dose is 1-2 g/kg body weight if administered 2

Poison Control Consultation

Immediately contact your regional poison center for case-specific guidance. 1

• In the United States, call 1-800-222-1222 to reach board-certified medical toxicologists with specialized training in poisoning resuscitation 1
• Poison centers provide expert treatment guidance that is essential for managing uncommon ingestions like paradichlorobenzene 1
• Do not delay supportive care while awaiting poison control consultation 1

Monitoring and Supportive Management

Focus on organ-specific toxicity monitoring based on paradichlorobenzene's known effects. 1

• Monitor for CNS depression, as paradichlorobenzene can cause altered mental status and seizures 1
• Assess for hepatotoxicity with liver function tests, as aromatic hydrocarbons can cause hepatic injury 1
• Monitor renal function, as kidney injury may occur with significant exposures 1
• Watch for hemolytic anemia, particularly in patients with G6PD deficiency 1
• Provide symptomatic treatment for nausea, vomiting, or abdominal pain as needed 1

Key Clinical Pitfalls

Avoid common errors that worsen outcomes in poisoning cases. 1, 2

• Do not delay airway management while attempting decontamination procedures 1, 2
• Do not induce emesis with ipecac, as this is no longer recommended and increases aspiration risk 2, 3
• Do not assume the patient ingested only paradichlorobenzene—mixed ingestions are common and require broader toxicological assessment 1
• Do not provide supplemental oxygen unnecessarily if the patient is maintaining adequate saturation, as hyperoxia may worsen certain toxicities 4