Hemoperfusion in acute camphor poisoning

Abstract

After ingestion of an unknown dose of a 10% camphor spirit (maximum dose 200 ml), a 54-year-old female was found in coma, having developed grand-mal-like seizures and respiratory failure. For detoxification, gastric lavage and hemoperfusion with amberlite XAD4 were performed. During hemoperfusion, seizures ceased, but no marked influence on the clinical course of the intoxication--especially on grade of coma--was observed. For further evaluation of the efficacy of treatment, camphor plasma elimination kinetics during hemoperfusion were compared to plasma elimination kinetics determined in a volunteer after an oral dose of 200 mg of camphor. Although the plasma compartment was almost completely (89%-95%) cleared of camphor by hemoperfusion, only a total of 35 mg of camphor was removed due to its high apparent volume of distribution (estimated 2-4 l/kg). The plasma elimination half-life was not affected by hemoperfusion, which may be explained by the saturation of metabolizing enzymes, still incomplete absorption, or metabolic interference of isopropanol. In the case presented here, neither the clinical course of the intoxication nor plasma level data gave evidence for a pronounced beneficial effect of hemoperfusion.

Camphor Induced Myocarditis: A Case Report

“…All these features retrospectively point to the toxic effects of camphor directly on the myocardium, which were reversible corresponding to the short half-life of camphor (167 min for a small dose of 200 mg of camphor) [8]. This report presents a unique case of camphor induced myocarditis.…”

Deadly pediatric poisons: nine common agents that kill at low doses

“…Persistent seizures may be managed with barbiturates. Hemoperfusion has been attempted, but not shown to alter clinical course and outcome [63].…”

Camphor Poisoning: an Evidence-Based Practice Guideline for Out-of-Hospital Management

“…Generalized tonic-clonic convulsions are often the first sign of significant toxicity and can occur soon after ingestion (8)(9)(10)(11). Central nervous system depression is commonly seen, as are headache, dizziness, confusion, agitation, anxiety, hallucinations, myoclonus, and hyperreflexia (6,7,(12)(13)(14)(15)(16)(17)(18). Death is usually the result of respiratory failure or convulsions (6,12,19,20).…”

“…There was a level 4 case report of a 54-year-old woman who ingested an unknown amount, but no more than 200 mL, of camphor spirits and developed coma, respiratory depression, and convulsions (18).…”

“…There were a number of anecdotal reports describing temporal improvement in convulsions, agitation, or excessive neuromuscular activity in patients with camphor toxicity after the administration of benzodiazepines or barbiturates (6,7,9,14,(16)(17)(18)22,25,26,(48)(49)(50)60,62,63,73,74). There was a single report of some improvement after phenytoin administration (62).…”