What is the appropriate immediate management of camphor poisoning?

Management of Camphor Poisoning

Camphor poisoning requires immediate supportive care with aggressive seizure management using benzodiazepines, as there is no specific antidote and gastrointestinal decontamination is contraindicated due to high aspiration risk. 1

Immediate Stabilization and Airway Management

• Secure the airway immediately and provide respiratory support as the foundational step, particularly in patients with altered mental status or active seizures 2, 3
• Administer supplemental oxygen and monitor oxygen saturation continuously to maintain adequate tissue oxygenation 2
• Intubate early if the patient has worsening mental status, recurrent seizures, or inability to protect the airway 3
• Establish intravenous access for fluid resuscitation and medication administration 3
• Monitor vital signs continuously including blood pressure, heart rate, respiratory rate, and oxygen saturation 2

Seizure Management: The Primary Life-Threatening Complication

• Administer benzodiazepines immediately for seizure control—this is the cornerstone of camphor poisoning treatment 1, 3
• Use diazepam as first-line or midazolam as alternative benzodiazepine 1
• Seizures can occur as early as 5-15 minutes after ingestion and are the most common serious complication requiring anticipation and rapid treatment 2, 3
• Continue benzodiazepine administration as needed for recurrent seizures, which are common in camphor toxicity 3

Cardiac Monitoring and ECG Assessment

• Obtain immediate ECG and monitor continuously for dysrhythmias, QRS widening, and QT prolongation 3
• Pay special attention to QRS complex widening as camphor has sodium channel blocking properties similar to other cardiotoxic agents 3
• Monitor for cardiac arrhythmias including tachycardia, bradycardia, and potentially life-threatening ventricular dysrhythmias 2, 3

Gastrointestinal Decontamination: What NOT to Do

• Do NOT induce emesis with ipecac syrup—this is contraindicated and increases aspiration risk given camphor's rapid onset of CNS toxicity 1
• Do NOT perform gastric lavage—contraindicated due to lack of proven benefit and significant risks including aspiration pneumonia, dysrhythmias, and esophageal perforation 1
• Do NOT administer activated charcoal for camphor ingestion alone, as the risk of aspiration outweighs any potential benefit 1
• Activated charcoal may only be considered if co-ingested substances are present that would benefit from charcoal adsorption 1

Risk Stratification and Disposition

• Refer immediately to the emergency department if the patient has ingested more than 30 mg/kg of camphor or exhibits moderate to severe symptoms (seizures, lethargy, ataxia, severe nausea/vomiting) 1
• As little as 500 mg can cause mortality in children, and 750-1000 mg are commonly associated with seizures and death 4
• Products containing 10% camphor have 500 mg in just 5 mL, making even small ingestions potentially lethal in young children 4
• Asymptomatic patients can be observed at home if they remain symptom-free for 4 hours after exposure 1
• Transport patients with active seizures via emergency medical services with benzodiazepine administration en route 1

Poison Control Consultation

• Contact the regional poison control center immediately (1-800-222-1222 in the United States) for expert toxicology guidance and case-specific recommendations 1
• Board-certified medical toxicologists can provide specialized treatment guidance for complex or severe cases 1

Monitoring for Complications

• Monitor for aspiration pneumonitis, which can occur from vomiting in the setting of camphor's low viscosity and high volatility 2
• Assess hepatic function as elevated liver enzymes can occur with camphor toxicity 5
• Monitor renal function for acute kidney injury, particularly in severe poisoning 5
• Watch for severe metabolic acidosis, which can develop rapidly in significant ingestions 5
• Assess for neurological sequelae including memory loss, which may persist even after clinical recovery 5

Topical and Inhalation Exposures

• For topical skin exposures, wash thoroughly with soap and water and observe at home for symptom development if the patient remains asymptomatic 1
• For eye splash exposures, irrigate copiously and refer based on presence and severity of symptoms 1
• For inhalation exposures, move the patient to fresh air immediately and refer based on symptom severity—symptoms are unlikely to progress once removed from the exposure environment 1

Critical Pitfalls to Avoid

• Do not delay benzodiazepine administration—seizures are the primary cause of morbidity and mortality and require immediate treatment 1, 3
• Do not underestimate small ingestions, particularly in children under 6 years where 500 mg or more requires immediate emergency department evaluation 4
• Do not assume the patient ingested only camphor—assess for co-ingestions that may require different management strategies 1
• Do not delay airway management while attempting decontamination procedures, which are contraindicated 1
• Do not refer patients with intentional self-harm for home observation—these patients require immediate emergency department referral regardless of dose 1