Abstract
Introduction: Naphthalene toxicity is an unusual form of poisoning and poses a diagnostic and therapeutic challenge due to its rare occurrence and complicated clinical course. Case Report: We report a case of naphthalene toxicity from non-accidental, non-suicidal ingestion of mothballs in a 56 year old male who presented with methemoglobinemia, hemolytic anemia and respiratory failure. He was treated with supportive management with blood transfusions, urinary alkalinization; hemodialysis for acute kidney injury and he also required noninvasive ventilation for hypoxemic respiratory failure. Discussion: The crucial aspect in the acute management of any poisoning is knowledge about its toxic manifestations, lethal dose and options for treatment including available antidotes. Mothball poisoning is rarely encountered in North America and awareness of its toxicity and treatment is crucial as the history may not be forthcoming in many instances. In many parts of the world naphthalene containing mothballs are still available commercially. We discuss the method for determining the more toxic form of mothball poisoning and the spectrum of its toxicity. We review the multidisciplinary approach to manage its complicated clinical course including possible antidotes.
Highlights
Naphthalene toxicity is an unusual form of poisoning and poses a diagnostic and therapeutic challenge due to its rare occurrence and complicated clinical course.Case Report: We report a case of naphthalene toxicity from non-accidental, non-suicidal ingestion of mothballs in a 56 year old male who presented with methemoglobinemia, hemolytic anemia and respiratory failure
Naphthalene toxicity is a rare form of poisoning and poses a diagnostic and therapeutic challenge due to its complicated clinical course
We report a case of naphthalene toxicity from non-accidental, nonsuicidal ingestion of mothballs in a 56 year old male who developed methemoglobinemia, hemolytic anemia and respiratory failure
Summary
Mothballs may contain naphthalene or paradichlorbenzene (PDCB). Mothballs are used to protect clothing and fabrics from moths by acting as insecticides. As the toxicity from naphthalene is severe and can be fatal, differentiation from PDCB is crucial. Naphthalene mothball sinks in water and floats in salt solution where as a paradichlorbenzene mothball sinks in both. This simple test helped us identify the more severe form of poisoning in our patient. Patients with low tolerance to oxidative stress like those with G6PD deficiency are at higher risk for hemolysis. G6PD deficiency results in low levels of NADPH which is required for methylene blue to be effective. In cases of unknown poisoning or acute cases of hemolysis, naphthalene toxicity must be considered as part of the differential diagnosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
