Журнал клинической токсикологии
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Methemoglobinemia and Uremia from an Unusual Poison

Arjun Sekar, Subhash Paudel, Siva P Sivakumar and Ashish Verma

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.