A cluster of children with seizures caused by camphor poisoning.
BACKGROUND
Isolated cases of camphor-induced seizures have been reported in young children after gastrointestinal, dermal, and inhalation exposure. In 1982, after a series of unintentional ingestions of camphor products, the US Food and Drug Administration restricted the camphor content to <11% in some products intended for medicinal use. Camphor products intended for use as pesticides must be registered with the US Environmental Protection Agency. Still, many imported camphor-containing products fail to meet Food and Drug Administration and Environmental Protection Agency requirements for labeling and content.


OBJECTIVE
To describe a cluster of cases of camphor-associated seizure activity resulting from the availability of imported camphor products in certain ethnic populations that use it as a natural remedy.


METHODS
We present 3 cases of seizures associated with imported, illegally sold camphor in young children who presented to a large, urban children's hospital in Bronx, New York, during a 2-week period.


RESULTS
The children's ages ranged from 15 to 36 months. Two children ingested camphor, and 1 child was exposed through repetitive rubbing of camphor on her skin. All 3 patients required pharmacologic intervention to terminate the seizures. One patient required bag-valve-mask ventilation for transient respiratory depression. All 3 patients had leukocytosis, and 2 patients had hyperglycemia. Exposure occurred as a result of using camphor for spiritual purposes, cold remedy, or pest control. After identification of these cases, the New York City Department of Health released a public health warning to keep camphor products away from children. Similar warnings were issued later by other state health departments.


CONCLUSIONS
These cases highlight the toxicity associated with camphor usage in the community and that inappropriate use of illegally sold camphor products is an important public health issue. Camphor may be a common, yet unrecognized, source of seizures in children in certain ethnic populations that use it as a natural remedy. Efforts are needed to educate the communities about the hazards of using camphor products and to limit the illegal availability of these products.
Khine
Hnin
H
Division of Pediatric Emergency Medicine, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, 111 E 210th St, Bronx, NY 10467, USA. hkhine@montefiore.org
Weiss
Don
D
Graber
Nathan
N
Hoffman
Robert S
RS
Esteban-Cruciani
Nora
N
Avner
Jeffrey R
JR
D000293:Adolescent; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000506:poisoning*; D002164:Camphor / Q000506:poisoning*; D002648:Child; D016000:Cluster Analysis; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced; D005260:Female; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D011041:Poisoning / Q000453:epidemiology; D012008:Recurrence; D012640:Seizures / Q000139:chemically induced* / Q000628:therapy; D014505:Urban Population; D055815:Young Adult
D000891:Anti-Infective Agents, Local; D002164:Camphor