Naphthalene

CAS RN: 91-20-3

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Care is symptomatic and supportive. Treat nausea and vomiting with antiemetics.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Care is symptomatic and supportive. Treat symptomatic methemoglobinemia with methylene blue. Severe hemolysis may require transfusion.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: INGESTION: Gastrointestinal decontamination is not recommended because of the risk for seizures and subsequent aspiration.
    • 2) HOSPITAL: INGESTION: Administer activated charcoal if the patient is alert and able to protect the airway. Activated charcoal may be effective for many hours after a mothball ingestion because they dissolve slowly.
  • D) ANTIDOTE
    • 1) None.
  • E) SEIZURES
    • 1) Administer a benzodiazepine IV: DIAZEPAM: ADULT: 5 to 10 mg, repeat every 10 to 15 minutes as needed. CHILD: 0.2 to 0.5 mg/kg, repeat every 5 minutes as needed OR LORAZEPAM: ADULT: 2 to 4 mg; CHILD: 0.05 to 0.1 mg/kg. Consider phenobarbital or propofol if seizures recur after diazepam 30 mg (adult) or 10 mg (children over 5 years of age). Monitor for hypotension, dysrhythmias, respiratory depression, and need for endotracheal intubation. Evaluate for hypoglycemia, electrolyte disturbances, and hypoxia.
  • F) METHEMOGLOBINEMIA
    • 1) Initiate oxygen therapy. Treat with methylene blue if patient is symptomatic (usually at methemoglobin concentrations greater than 20% to 30% or at lower concentrations in patients with anemia, underlying pulmonary or cardiovascular disease). METHYLENE BLUE: INITIAL DOSE/ADULT OR CHILD: 1 mg/kg IV over 5 to 30 minutes; a repeat dose of up to 1 mg/kg may be given 1 hour after the first dose if methemoglobin levels remain greater than 30% or if signs and symptoms persist. NOTE: Methylene blue is available as follows: 50 mg/10 mL (5 mg/mL or 0.5% solution) single-dose ampules and 10 mg/1 mL (1% solution) vials. Additional doses may sometimes be required. Improvement is usually noted shortly after administration if diagnosis is correct. Consider other diagnoses or treatment options if no improvement has been observed after several doses. If intravenous access cannot be established, methylene blue may also be given by intraosseous infusion. Methylene blue should not be given by subcutaneous or intrathecal injection. NEONATES: DOSE: 0.3 to 1 mg/kg.
  • G) ENHANCED ELIMINATION
    • 1) Hemodialysis is NOT LIKELY to be effective; however, it has been used in supportive care.
  • H) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Older reports suggest that ingestion of one mothball may cause hemolysis. The vast majority of cases were clearly associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Therefore, patients with G6PD deficiency should be referred for evaluation. Asymptomatic healthy children with ingestion of a single mothball (or less) can be monitored at home.
    • 2) OBSERVATION CRITERIA: Any patient with deliberate ingestion with known G6PD deficiency, or with symptoms, should be referred to a healthcare facility. A child ingesting more than one mothball should be referred to a healthcare facility. If laboratory findings are negative and the patient is asymptomatic during a 4 to 6 hour observation period, the patient may be discharged with instructions to return for a follow-up CBC and urinalysis for up to 5 days postingestion. Patients should be instructed to return if any gastrointestinal symptoms, pallor, dark or diminished urine output, or CNS symptoms develop.
    • 3) ADMISSION CRITERIA: Children or adults with G6PD deficiency should be admitted for monitoring. Admit any patient with evidence of anemia, hemolysis, or hemoglobinuria, or those with persistent nausea or vomiting who are unable to tolerate food or liquids by mouth.
    • 4) CONSULT CRITERIA: Please consult a medical toxicologist or a local poison control center for all exposures in patients exhibiting signs or symptoms of systemic toxicity or those patients requiring observation or admission.
  • I) PITFALLS
    • 1) Failure to recognize that hemolysis may be delayed. Patients who are discharged should be instructed to return if they develop red or brown urine or develop symptoms of methemoglobinemia.
  • J) PHARMACOKINETICS
    • 1) Oral absorption is erratic. Naphthalene undergoes hepatic metabolism with renal excretion of metabolites.
  • K) DIFFERENTIAL DIAGNOSIS
    • 1) Paradichlorobenzene exposure. All causes of methemoglobinemia or hemolysis such as a local anesthetic exposure or glucose-6-phosphate dehydrogenase (G6PD) deficiency.
0.4.3 INHALATION EXPOSURE
  • A) Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with inhaled beta2 agonist and oral or parenteral corticosteroids.
0.4.4 EYE EXPOSURE
  • A) Irrigate exposed eyes with copious amounts of room temperature water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist, the patient should be seen in a health care facility.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) Remove contaminated clothing and wash exposed area thoroughly with soap and water. A physician may need to examine the area if irritation or pain persists.
Find more information on this substance at: PubChem, PubMed