Terpene Toxicity Clinical Presentation

  • Author: John Said Kashani, DO; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 6, 2011
 

History

  • Elicit the exact substance[5] that the patient was exposed to, and the concentration of terpene should be noted.
  • Toxicity may first present with GI symptoms of nausea and vomiting.
  • In severe ingestions, seizures have been reported;[6] they are often single and self-limited.
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Physical

  • Respiratory symptoms from aspiration may occur early.
  • A careful examination of the chest and lungs is essential. CNS depression may occur early in the ingestion of a concentrated product or large ingestion.
  • Seizures may occur early in exposure and tend to be single and self-limited.
  • Cardiac arrhythmias have been reported; however, vital signs are usually normal.
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Causes

  • Most exposures are the result of an unintentional ingestion.
  • Some subcultures of society continue to use turpentine as an antihelminthic, purgative, and general elixir of good health. This practice may produce the potentially disastrous situation where the product is available and considered to be innocuous.
  • Camphorated oil often is supplied in small bottles that closely resemble castor oil. The bottles may be kept on pharmacy or grocery store shelves next to each other so that an individual with vision impairment may easily choose the incorrect preparation.
  • A case report described camphor toxicity in a 35-year-old Cambodian male with diarrhea, vomiting, and altered mental status. He was described as having parallel and symmetric ecchymotic streaks on his back as a result "coining". In this case, toxicity occurred by the application of camphor to the skin prior to coining. Toxicity occurred presumably by transcutaneous absorption.
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Contributor Information and Disclosures
Author

John Said Kashani, DO  Assistant Medical Director of the New Jersey Poison ad Information Education System; Assistant Professor, Department of Preventive Medicine and Community Health, Assistant Professor, Department of Pediatrics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey

John Said Kashani, DO is a member of the following medical societies: American College of Emergency Physicians and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Coauthor(s)

Steven Marcus, MD  Professor, Department of Preventive Medicine and Community Health, Associate Professor, Department of Pediatrics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey; Executive and Medical Director, New Jersey Poison Information and Education System; Consulting Staff, Departments of Pediatrics and Internal Medicine, University Hospital, University of Medicine and Dentistry of New Jersey; Consulting Staff, Department of Pediatrics, Newark Beth Israel Medical Center

Steven Marcus, MD is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Clinical Toxicology, American Academy of Pediatrics, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, and Medical Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

Lance W Kreplick, MD, FAAEM, MMM  Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, FAAEM, MMM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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