Camphor poisoning


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    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

  • See also:

    Poisoning – acute guidelines for initial management 
    Resuscitation

    Key Points

    1. Camphor is highly toxic.
    2. Onset of symptoms can be early, within 15 mins of ingestion of more than 30mg/kg.
    3. Neurologic complications are common. Seizures can occur within 90 mins of ingestion.

    For 24 hour advice contact, the Victorian Poisons Information Centre on 13 11 26     

    Background

    Camphor is highly toxic. While it is readily absorbed from the skin most toxic exposure is from ingestion.

    Common substances containing camphor include:

      • Vicks Inhaler
      • Rubs including : Dencorub, Tiger balm, Emu Oils, Vicks VapoRub
      • Mothballs (some mothballs instead contain naphthalene)

    The Victorian Poisons Information Centre does not recommend the use of camphor, as it has no proven health benefits, and is unsafe in houses.  (See: Parent information sheet from Victorian Poisons Information centre link below)

    Pharmacokinetics:

    • Onset of symptoms can be early, 5-15 minutes post ingestion; peak plasma  concentrations occur 1-3 hours post ingestion
    • Clinical toxicity typically resolves within 24 hours
    • Oxidised and conjugated by the liver, renally excreted
    • Dose related toxicity: 0.5-1g is considered a lethal oral dose in children.   

    Patients requiring assessment

    All patients with deliberate self-poisoning or significant accidental ingestion
    Any symptomatic patient
    Children who have ingested more than 30 mg/kg.
    Any patient whose developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered.

    Risk Assessment

    History

    Intentional overdose or accidental ingestion

    Dose:

    • Stated or likely dose taken
    • Calculate the maximum possible dose per kg

    Consider co-ingestants eg paracetamol

    Examination 

    Often a characteristic odour is present
    Neurologic complications are common. Acute seizures usually occur within 90 minutes of ingestion. They may be preceded by muscle fasciculation, confusion, delirium, hallucinations, and restlessness.
    Respiratory depression is common, often following seizure
    GIT: oral/epigastric burning, nausea, vomiting
    CVS: case reports of cardiomyopathy and prolonged QRS and QTc

    Investigations

    Paracetamol level in all intentional overdoses
    ECG and CXR if symptomatic

    Acute Management

    Resuscitation

    Standard procedures and supportive care 

    Decontamination 

    Wash contaminated areas of skin and remove patient's clothes if indicated. 
    Charcoal is not recommended.

    Ongoing care and monitoring

    If asymptomatic; 
    Observe for 4 hours & discharge if no symptoms develop.
    If symptomatic;
    Needs urgent medical assessment.
    Enhance elimination – ineffective
    Antidote – Nil

    When to admit/consult local paediatric team, or who/when to phone:

    Admission should be considered for all adolescent patients with an intentional overdose, especially if there are

    • Significant or persistent vomiting or diarrhoea
    • Seizures
    • Decreased conscious state
    • Respiratory depression

    Consult Contact Victorian Poisons Information Centre 131126 for advice

    When to consider transfer to a tertiary centre:

    Patient requiring respiratory support

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Discharge Criteria:

    • Normal GCS
    • Period of observation as above
    • For deliberate ingestion a risk assessment should indicate that the patient is at low risk of further self-harm.

    Discharge information and follow-up:

    Accidental ingestion: Parent information sheet from Victorian Poisons Information centre on the prevention of poisoning         

    Intentional self –harm: Referral to local mental health services eg Orygen Youth Health: 1800 888 320 

    Last Updated June 2017