Terpene Toxicity 

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

Background

Terpenes are natural products derived from plants that have medicinal properties and biological activity. Terpenes may be found in cleaning products, rubefacients, aromatherapy, and various topical preparations. Terpenes may exist as hydrocarbons or have oxygen-containing compounds such as ketone or aldehyde groups (terpenoids).

The basic structure of terpenes is repeating isoprene units (C5H8)n, and they are grouped according to the number of repeating isoprene units. Monoterpenes contain 2 isoprene units; examples include cantharidin, menthol, pinene, and camphor. Diterpenes contain 4 isoprene units; examples include phytol, vitamin A1[1] , and paclitaxel (Taxol).

The best-known compounds in this group are camphor oil and turpentine. The antineoplastic agent paclitaxel is a terpene derived from yew plant bark. An oil derived from the Saliva officinalis tree, thujone, has recently become popular because of its hallucinogenic qualities, and it is quickly becoming a drug of abuse.[2]

Absinthe, a green liquor containing thujone, has been thought to be responsible for enhancing the creativity of many famous artists including Edouard Manet, Vincent Van Gogh, and Henri de Toulouse-Lautrec.

Next

Pathophysiology

Terpenes are local irritants and, thus, are capable of causing GI signs and symptoms. CNS manifestations may range from an altered mental status to seizures to coma. Aspiration is a particular concern and can result in fatalities and long-term complications.

Absorption begins in the oral cavity and is rapid as evidenced by the early onset of toxicity in significant ingestions. Terpenes are metabolized through cytochrome P450 and are excreted as conjugated metabolites by the kidney.

Previous
Next

Epidemiology

Frequency

United States

According to the 2009 Annual Report of the American Association of Poison Control National Poison Data System, 3362 single exposures to disinfectants containing pine oil, 10,714 single exposures to camphor, and 422 single exposures to turpentine were reported.[3] Exposure to pine oil resulted in 2 deaths, and exposure to turpentine resulted in 1 death. No deaths resulted from exposure to camphor.[3]

Mortality/Morbidity

Morbidity and mortality[4] associated with exposure to terpenes is largely related to the degree of CNS depression and if aspiration occurs. Despite the toxicity of these agents, morbidity is extremely low.

Sex

Males overrepresent cases associated with terpenes.

Age

Most exposures are the result of unintentional exposures in childhood.

Previous
Proceed to Clinical Presentation
 
 
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

  1. Lam HS, Chow CM, Poon WT, Lai CK, Chan KC, Yeung WL. Risk of vitamin A toxicity from candy-like chewable vitamin supplements for children. Pediatrics. Aug 2006;118(2):820-4. [Medline].

  2. Bucheler R, Gleiter CH, Schwoerer P, Gaertner I. Use of nonprohibited hallucinogenic plants: increasing relevance for public health? A case report and literature review on the consumption of Salvia divinorum (Diviner's Sage). Pharmacopsychiatry. Jan 2005;38(1):1-5. [Medline].

  3. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline]. [Full Text].

  4. Soo Hoo GW, Hinds RL, Dinovo E, Renner SW. Fatal large-volume mouthwash ingestion in an adult: a review and the possible role of phenolic compound toxicity. J Intensive Care Med. May-Jun 2003;18(3):150-5. [Medline].

  5. Myhre AM, Carlsen MH, Bøhn SK, Wold HL, Laake P, Blomhoff R. Water-miscible, emulsified, and solid forms of retinol supplements are more toxic than oil-based preparations. Am J Clin Nutr. Dec 2003;78(6):1152-9. [Medline].

  6. Khine H, Weiss D, Graber N, Hoffman RS, Esteban-Cruciani N, Avner JR. A cluster of children with seizures caused by camphor poisoning. Pediatrics. May 2009;123(5):1269-72. [Medline].

  7. [Guideline] Manoguerra AS, Erdman AR, Wax PM, Nelson LS, Caravati EM, Cobaugh DJ. Camphor Poisoning: an evidence-based practice guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(4):357-70. [Medline]. [Full Text].

  8. Brook MP, McCarron MM, Mueller JA. Pine oil cleaner ingestion. Ann Emerg Med. Apr 1989;18(4):391-5. [Medline].

  9. Dalgarno P. Subjective effects of Salvia divinorum. J Psychoactive Drugs. Jun 2007;39(2):143-9. [Medline].

  10. Decker WJ, Corby DG, Hilburn RE, Lynch RE. Adsorption of solvents by activated charcoal, polymers, and mineral sorbents. Vet Hum Toxicol. 1981;23(Suppl 1):44-6. [Medline].

  11. Gambelunghe C, Melai P. Absinthe: enjoying a new popularity among young people?. Forensic Sci Int. Dec 4 2002;130(2-3):183-6. [Medline].

  12. Guillen MD, Manzanos MJ. Extractable components of the aerial parts of Salvia lavandulifolia and composition of the liquid smoke flavoring obtained from them. J Agric Food Chem. Aug 1999;47(8):3016-27. [Medline].

  13. Lai MW, Klein-Schwartz W, Rodgers GC, Abrams JY, Haber DA, Bronstein AC. 2005 Annual Report of the American Association of Poison Control Centers' national poisoning and exposure database. Clin Toxicol (Phila). 2006;44(6-7):803-932. [Medline].

  14. Love JN, Sammon M, Smereck J. Are one or two dangerous? Camphor exposure in toddlers. J Emerg Med. Jul 2004;27(1):49-54. [Medline].

  15. Olsen RW. Absinthe and gamma-aminobutyric acid receptors. Proc Natl Acad Sci U S A. Apr 25 2000;97(9):4417-8. [Medline].

  16. Ragucci KR, Trangmar PR, Bigby JG, Detar TD. Camphor ingestion in a 10-year-old male. South Med J. Feb 2007;100(2):204-7. [Medline].

  17. Rampini SK, Schneemann M, Rentsch K, Bachli EB. Camphor intoxication after cao gio (coin rubbing). JAMA. Jul 3 2002;288(1):45. [Medline].

  18. Riordan M, Rylance G, Berry K. Poisoning in children 4: household products, plants, and mushrooms. Arch Dis Child. Nov 2002;87(5):403-6. [Medline].

  19. Rodricks A, Satyanarayana M, D'Souza GA, Ramachandran P. Turpentine-induced chemical pneumonitis with broncho-pleural fistula. J Assoc Physicians India. Jul 2003;51:729-30. [Medline].

  20. Shannon M, McElroy EA, Liebelt EL. Toxic seizures in children: case scenarios and treatment strategies. Pediatr Emerg Care. Jun 2003;19(3):206-10. [Medline].

  21. Wilson CR, Sauer J, Hooser SB. Taxines: a review of the mechanism and toxicity of yew (Taxus spp.) alkaloids. Toxicon. Feb-Mar 2001;39(2-3):175-85. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.