Prehospital Care

Induction of emesis is contraindicated because of the risk of aspiration. Terpenes are not adsorbed by charcoal. It is best to not administer anything by mouth. Careful attention should be paid to the patient's airway.

Treatment guidelines on management of camphor exposure are available from the American Association of Poison Control Centers.^[16]

Emergency Department Care

If the patient is asymptomatic, no immediate intervention is warranted. Supportive measures may be all that is needed. Seizures should be managed with benzodiazepines. Gastric emptying is not recommended.

Consultations

Pulmonary consultation may be required if aspiration has occurred. Consider consultation with a poison control center or medical toxicologist. Psychiatric consultation is necessary in cases with deliberate exposure. Counseling may be indicated in exposures as a result of folk remedies.

Prevention

All household products, medications, and chemicals should be safely stored away in their original packages. Medications should never be taken or applied to the skin without first reading the label carefully.

Camphor is found in many essential oils. It freely crosses the placenta and at high doses may cause damage to fetal organs including the liver, kidney and brain. Women should avoid using products containing camphor during pregnancy and while breastfeeding.^[17]

Long-Term Monitoring

Long-term follow-up care is necessary if pneumonitis develops.

Medication

Kolassa N. Menthol differs from other terpenic essential oil constituents. Regul Toxicol Pharmacol. 2013 Feb. 65(1):115-8. [QxMD MEDLINE Link].
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. 2006 Aug. 118(2):820-4. [QxMD MEDLINE Link].
Sokolova AS, Yarovaya CO, Shernyukov CA, Pokrovsky CE, Pokrovsky CA, Lavrinenko VA, et al. New quaternary ammonium camphor derivatives and their antiviral activity, genotoxic effects and cytotoxicity. Bioorg Med Chem. 2013 Nov 1. 21(21):6690-8. [QxMD MEDLINE Link].
Ojima I, Lichtenthal B, Lee S, Wang C, Wang X. Taxane anticancer agents: a patent perspective. Expert Opin Ther Pat. 2016. 26 (1):1-20. [QxMD MEDLINE Link]. [Full Text].
Zawilska JB, Wojcieszak J. Salvia divinorum: from Mazatec medicinal and hallucinogenic plant to emerging recreational drug. Hum Psychopharmacol. 2013 Sep. 28 (5):403-12. [QxMD MEDLINE Link].
Gambelunghe C, Melai P. Absinthe: enjoying a new popularity among young people?. Forensic Sci Int. 2002 Dec 4. 130(2-3):183-6. [QxMD MEDLINE Link].
Absinthe. Wikipedia. Available at https://en.wikipedia.org/wiki/Absinthe. Accessed: April 29, 2023.
Lachenmeier DW, Nathan-Maister D, Breaux TA, Sohnius EM, Schoeberl K, Kuballa T. Chemical composition of vintage preban absinthe with special reference to thujone, fenchone, pinocamphone, methanol, copper, and antimony concentrations. J Agric Food Chem. 2008 May 14. 56 (9):3073-81. [QxMD MEDLINE Link]. [Full Text].
Love JN, Sammon M, Smereck J. Are one or two dangerous? Camphor exposure in toddlers. J Emerg Med. 2004 Jul. 27(1):49-54. [QxMD MEDLINE Link].
Rampini SK, Schneemann M, Rentsch K, Bachli EB. Camphor intoxication after cao gio (coin rubbing). JAMA. 2002 Jul 3. 288(1):45. [QxMD MEDLINE Link].
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Rivers LJ, Feldman R, et al. 2021 Annual Report of the National Poison Data System(©) (NPDS) from America's Poison Centers: 39th Annual Report. Clin Toxicol (Phila). 2022 Dec. 60 (12):1381-1643. [QxMD MEDLINE Link]. [Full Text].
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. 2003 May-Jun. 18(3):150-5. [QxMD MEDLINE Link].
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. 2003 Dec. 78(6):1152-9. [QxMD MEDLINE Link].
Khine H, Weiss D, Graber N, Hoffman RS, Esteban-Cruciani N, Avner JR. A cluster of children with seizures caused by camphor poisoning. Pediatrics. 2009 May. 123(5):1269-72. [QxMD MEDLINE Link].
Rahimi M, Shokri F, Hassanian-Moghaddam H, Zamani N, Pajoumand A, Shadnia S. Severe camphor poisoning, a seven-year observational study. Environ Toxicol Pharmacol. 2017 Jun. 52:8-13. [QxMD MEDLINE Link].
[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. [QxMD MEDLINE Link]. [Full Text].
Dosoky NS, Setzer WN. Maternal Reproductive Toxicity of Some Essential Oils and Their Constituents. Int J Mol Sci. 2021 Feb 27. 22 (5):[QxMD MEDLINE Link]. [Full Text].
Brook MP, McCarron MM, Mueller JA. Pine oil cleaner ingestion. Ann Emerg Med. 1989 Apr. 18(4):391-5. [QxMD MEDLINE Link].

Media Gallery

of 0

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, American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and 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, 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.

Additional Contributors

Lance W Kreplick, MD, FAAEM, MMM, UHM Staff Physician, Teladoc Health; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, FAAEM, MMM, UHM is a member of the following medical societies: American Academy of Emergency Medicine, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Steven Marcus, MD Professor, Department of Preventive Medicine and Community Health, Associate Professor, Department of Pediatrics, Rutgers New Jersey Medical School, Rutgers University School of Biomedical and Health Sciences; Executive and Medical Director, New Jersey Poison Information and Education System; Consulting Staff, Departments of Pediatrics and Internal Medicine, University Hospital; 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, Medical Society of New Jersey

Disclosure: Nothing to disclose.