Kerosene, Camphor, and Naphthalene Poisoning in Children

Abstract

Kerosene poisoning is one of the most common accidental poisoning in children in developing countries due common use of kerosene in household and unsafe storage practices. Aspiration pneumonitis is the most common manifestation of kerosene ingestion due to its low viscosity, high volatility, and low surface tension. The treatment of aspiration pneumonitis due to kerosene poisoning is symptomatic including oxygen support, respiratory monitoring, and careful monitoring of fluid balance. Children with severe respiratory distress and hypoxemia unresponsive to supplemental oxygen and/or severe central nervous system involvement require early intubation and mechanical ventilation. Transfer to the pediatric intensive care unit (PICU) is required at this stage. Emesis, gastric lavage, and administration of activated charcoal are contraindicated due to risk of aspiration. There is no clear benefit of using corticosteroids or prophylactic antibiotics. Asymptomatic children should be kept under observation for atleast 6 hours after exposure. The mortality rate is low and death occurs due to pneumonitis. Camphor is used in household items including vaporized or topical cold preparations, liniments, moth repellents, for performing rituals in religious ceremonies, and in antimicrobial preparations. Camphor poisoning is not very common in childhood. Even small doses of camphor can cause serious toxicity and is potentially fatal. The onset of action is very rapid (5-15 minutes). The common manifestations are confusion, restlessness, delirium, and hallucinations, muscle twitching, myoclonus, ataxia, hyperreflexia, fasciculations, and seizures. Seizures are common and serious complication in camphor toxicity. The treatment is supportive including decontamination, gastric lavage, activated charcoal, and seizure control. Naphthalene is a major constituent of mothballs which are commonly used in household to protect clothes from moths. Though the poisoning with naphthalene is uncommon in children, most of the cases with naphthalene poisoning occur in developing countries where mothballs are still commonly used. The manifestations of naphthalene toxicity are predominantly due to acute intravascular hemolysis leading to anemia, hemoglobinuria, methemoglobinemia, and acute kidney injury (AKI). The treatment of naphthalene toxicity is supportive in form of transfusion of the packed red blood cells, monitoring of fluid and electrolyte balance, administration of alkalis in presence of hemoglobinuria, and renal replacement therapy. Prevention is better than cure. The strategies should be adopted to prevent children being exposed to these toxic compounds in the house-hold. Safe storage of toxic compounds away from the reach of children, avoiding storing kerosene in cold drink and beverage bottles, community education, provision of electricity in rural areas, safe cooking practices, and parental supervision are important interventions to prevent accidental poisoning among children.

Accidental kerosene oil ingestion in under-five age children in Nigeria – The need for vigilance in primary care settings in low- and middle-income countries (LMICs)

“…[ 13 ] Antibiotics are not routinely prescribed unless secondary bacterial infection is suspected from contaminated kerosene or commensals in the respiratory tract. [ 14 ] Adequate diagnosis and management therefore requires quick access to comprehensive care at the primary level to prevent the occurrence of further complications, morbidity, and mortality.…”

Hydrocarbon poisoning in pediatric practice

“…Частота тяжелых респираторных нарушений значительно различается в разных исследованиях. Так, в наблюдении из Египта ИВЛ потребовалась 4 детям из 72, имевшим поражение легких [1,27]. Подробный алгоритм респираторной поддержки представлен в клинических рекомендациях Ассоциации клинических токсикологов 2020 г.…”

“…Несмотря на частое включение в терапию глюкокортикостероидов и антибиотиков, отсутствуют скольконибудь убедительные подтверждения их эффективности [1,32,42,43]. В ряде источников упоминается возможность присоединения бактериальной инфекции при деструктивных изменениях в более поздние сроки.…”

“…В США и европейских странах проблема отравлений детей углеводородами также является достаточно актуальной. Наиболее значимыми факторами риска признаны низкий социально-экономический уровень жизни, многодетность и проживание в сельской местности или в неблагоустроенных жилищах [1][2][3]. Различные национальные исследовательские группы обращают внимание на необходимость информирования о риске в отношении семей с детьми, а также профилактических мер в отношении упаковок средств, содержащих углеводороды 1 [2,4].…”

Ultrastructural changes of Basolateral Amygdaloid nuclei in the Sprague Dawley rats brain following exposure to naphthalene balls

“…If someone inhales in enough of the vapour or eats a mothball having naphthalene, they may progress to hemolytic anemia. Children have also established fever, abdominal pain, diarrhea, and discolored urine with painful urination after accidental intake of naphthalene balls (Angurana et al, 2019).…”