Camphor is a commonly seen household item which can cause severe poisoning even when taken in small amounts in children. Neurotoxicity in the form of seizures can occur soon after ingestion. Camphor is used in many vaporized or topical cold medications, topical musculo skeletal anesthetic preparations, moth repellants and in antimicrobial preparations. We report a child who presented with seizures due to ingestion of camphor used in religious ceremony.

A 3-year-old male child presented with history of consumption of camphor followed by two episodes of vomiting. He had accidentally consumed around two camphor cubes confusing it for sugar cubes. The family was using camphor for performing rituals in religious ceremonies. At admission, the child developed convulsions, with tonic posturing of limbs and uprolling of eyeballs. Interval between the onset of seizures and ingestion was around 30 minutes. Injection lorazepam was given to abort seizures. There were no other neurological deficits. Vital parameters were stable. Rests of the systems were normal. The child received stomach wash, ranitidine and intravenous fluids. He recovered completely within 24 hours and discharged after 2 days.

The easy availability of camphor in various forms put children at high risk of camphor poisoning. It is potentially fatal, even when taken in small doses in children [1]. It is remarkable for its rapidity of action. Camphor containing products can not exceed 11% of camphor as set by FDA, but in our country the concentration of camphor is not mentioned on the products.

Within 5-15 minutes patients commonly complain of mucous membrane irritation, nausea, vomiting and abdominal pain. Generalized convulsions are often the first sign of significant toxicity and can occur soon after ingestion [2]. Camphor induced seizures can occur after gastrointestinal, dermal or inhalation exposures [3]. One case of status epilepticus is reported following abdominal massage with camphor containing product [4]. Other CNS symptoms include headache, dizziness, confusion, agitation, anxiety, hallucinations, myoclonus, hyperreflexia and ataxia. CNS stimulation is followed by depression. Camphor can also cause hepatic and renal damage. Death is usually the result of respiratory failure or convulsions. Neurotoxicity is seen if ingestion of camphor is more than 50 mg/kg [5].

Treatment is primarily supportive with a focus on airway management and seizure control. Skin and ocular decontamination should be done by flushing with copious amounts of water. Patients with camphor inhalation should be moved to fresh air. Induction of emesis should not be performed. Gastric lavage is not helpful as camphor is rapidly absorbed. Activated charcoal may be considered if there are other ingredients that are effectively absorbed. Short acting anticonvulsants like lorazepam should be used to treat seizures. Barbiturates should be used if benzodiazepines are unsuccessful. Haemodialysis is not of much benefit.

Acknowledgment: Dr Sujata K, Associate Professor in the department.

1. Matteucci MJ. One pill can kill: assessing the potential for fatal poisonings in children. Pediatr Ann. 2005;34:964-8.

2. Manoguerra AS, Erdman AR, Wax PM, Nelson LS, Caravati M, Cobaugh DJ, et al. Camphor poisoning: an evidence based practice guidelines for out of hospital management. Clin Toxicol. 2006;44:357-70.

3. 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;123: 1269-72.

4. Gilbert J, Flamant C, Hallalel F, Doummar D, Frata A, Renolleau S. Antiflatulence treatment and status epilepticus- a case report of camphor intoxication. Emerg Med J. 2007;24:859-60.