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Goel A. Anti-oxidant therapy in management of acute naphthalene ball poisoning. J Anaesthesiol Clin Pharmacol 2024; 40:357-359. [PMID: 38919444 PMCID: PMC11196032 DOI: 10.4103/joacp.joacp_122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 06/27/2024] Open
Affiliation(s)
- Amit Goel
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
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Atusingwize E, Rohlman D, Hoffman P, Wafula ST, Musoke D, Buregyeya E, Mugambe RK, Ndejjo R, Ssempebwa JC, Anderson KA. Chemical contaminant exposures assessed using silicone wristbands among fuel station attendants, taxi drivers and commercial motorcycle riders in Kampala, Uganda. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023; 78:401-411. [PMID: 37916578 DOI: 10.1080/19338244.2023.2275144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
There are concerns over traffic-related air pollution in Uganda's capital, Kampala. Individuals in the transportation sector are hypothesized to be at greater risk for exposure to volatile organic compounds, given their proximity to vehicle exhaust. Silicone wristbands are a wearable technology that passively sample individuals' chemical exposures. We conducted a pilot cross sectional study to measure personal exposures to volatile organic compounds among 14 transportation workers who wore a wristband for five days. We analyzed for 75 volatile organic compounds; 33 chemicals (35%) were detected and quantified in at least 50% of the samples and 15 (16%) chemicals were detected and quantified across all the samples. Specific chemicals were associated with participants' occupation. The findings can guide future large studies to inform policy and practice to reduce exposure to chemicals in the environment in Kampala.
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Affiliation(s)
- Edwinah Atusingwize
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Diana Rohlman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Peter Hoffman
- Food Safety and Environmental Stewardship Program, Oregon State University, Corvallis, OR, USA
| | - Solomon Tsebeni Wafula
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - John C Ssempebwa
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Kim A Anderson
- Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, USA
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Anand V, Venkatesan DK, T P, Naseem M, Rathia SK. Methemoglobinemia Secondary to a Traditional Healing Practice Using Mothballs: A Need of Pediatric Vigilance. Cureus 2023; 15:e41192. [PMID: 37525810 PMCID: PMC10387263 DOI: 10.7759/cureus.41192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
Acute-onset unexplained hypoxemia persisting despite 100% oxygen has a limited differential diagnosis but poses a challenging diagnostic dilemma. Methemoglobinemia, a hemolytic condition, may lead to significant complications if it goes undiagnosed during the critical golden hour of an emergency department (ED) presentation. This case report presents the clinical details of a 30-month-old child with acute intravascular hemolysis evident by severe pallor and hemoglobinuria and severe hypoxia documented on pulse oximetry. During the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) of the primary survey, "exposure" revealed the parent's deliberate fastening of a mothball around the waist of the baby on the advice of a traditional healer, which was identified as the source of naphthalene toxicity. The swift intervention was undertaken for hypoxic respiratory compromise with 100% oxygen just after triage, and the naphthalene ball with the tied cloth was removed. Arterial blood gas and co-oximetry analysis confirmed the diagnosis of methemoglobinemia, and other laboratory tests suggested severe hemolytic anaemia as well as hemoglobinuria favouring intravascular hemolysis. With the exclusion of other common differentials for hemolytic anaemia, including sickle cell crisis, autoimmune hemolytic anaemia, hemolytic uremic syndrome, and G6PD deficiency, naphthalene exposure was considered the culprit for both hemolysis and methemoglobinemia. After obtaining the history of another similar episode of anaemia six months ago requiring blood transfusion, we retrospected on similar mothball exposure, but parents denied that, saying they were using the mothball only for the last 10 days on the advice of a local healer with intent to get rid of some evil power and sickness in their child. After analyzing the old records of prior hospitalization and getting assured of a normal report of G6PD level, intravenous methylene blue was administered. But in view of an inadequate response, a single blood volume exchange transfusion was performed during the ED stay only, which resulted in a notable reduction in subsequent methemoglobin levels and an improvement of the child's clinical condition by the second day. The child was discharged by the third day with no distress and no further episodes of hemoglobinuria, with detailed parental counselling and follow-up advice. This case underscores the imperative need for timely recognition and effective management of methemoglobinemia in the paediatric population while emphasizing the potential hazards associated with naphthalene exposure. Further comprehensive investigations are warranted to elucidate optimal treatment strategies and explore long-term outcomes in similar clinical scenarios.
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Affiliation(s)
- Varun Anand
- Trauma and Emergency/Pediatric Emergency Medicine, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Dilip K Venkatesan
- Pediatric Emergency Medicine, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Pugazhenthan T
- Pharmacology and Therapeutics, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Md Naseem
- Pediatric Emergency Medicine, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Santosh K Rathia
- Trauma and Emergency/Pediatric Emergency Medicine, All India Institute of Medical Sciences Raipur, Raipur, IND
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Irshad R, Asim S, Mansha A, Arooj Y. Naphthalene and its Derivatives: Efficient Fluorescence Probes for Detecting and Imaging Purposes. J Fluoresc 2023:10.1007/s10895-023-03153-y. [PMID: 36735102 DOI: 10.1007/s10895-023-03153-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
Naphthalene, white crystalline solid having polycyclic aromatic hydrocarbon with characteristic mothball order is naturally present in crucial oils of various plants. Naphthalene derivatives are extensive drug resources and are use as wetting agents, surfactants and as insecticides. These derivatives exhibit unique photo physical and chemical properties. These characteristics make them the most studied group of organic compounds. Naphthalene dyes have rigid plane and large π-electron conjugation. Therefor they have high quantum yield and excellent photostability. Naphthalene based fluorescence probes due to hydrophobic nature exhibit excellent sensing and selectivity properties towards anions and cations and also used as a part of target biomolecules. In conjugated probe system, introducing naphthalene moiety caused improvement in photo-stability. Therefore among various conjugated framework, naphthalene derivatives are considered excellent candidate for the construction of organic electronic appliances. These derivatives are useful for a variety of applications owing to their strong fluorescence, electroactivity and photostability. This article is based upon investigation of photophysical properties of naphthalene derivatives and fluorescence detecting probe of naphthalene. For photophysical properties the techniques under investigation are UV visible spectroscopy and fluorescence spectroscopy. Concentration dependent spectra and solvatochromic shifts on UV visible spectra are also part of discussion.
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Affiliation(s)
- Ruqaya Irshad
- Department of Physics, Government College Women University, Faisalabad, Pakistan
| | - Sadia Asim
- Department of Chemistry, Government College Women University, Faisalabad, Pakistan.
| | - Asim Mansha
- Department of Chemistry, Government College University, Faisalabad, Pakistan
| | - Yusra Arooj
- Department of Physics, Government College Women University, Faisalabad, Pakistan
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Paiva JHHGL, Júnior GBS, Magalhaes KDN, Cunha BL, Mota SMB, Daher EDF, Albuquerque PLMM. Acute kidney injury following naphthalene poisoning in children. Nefrologia 2022; 42:356-359. [PMID: 36210125 DOI: 10.1016/j.nefroe.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/14/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
| | - Geraldo Bezerra Silva Júnior
- Faculty of Medicine, Post-Graduate Program in Public Health and Medical Sciences of University of Fortaleza, Fortaleza, Ceara, Brazil
| | | | | | - Sandra Mara Brasileiro Mota
- Toxicological Information and Assistance Center, Instituto Doutor Jose Frota Hospital, Fortaleza, Ceara, Brazil; Post-Graduate Program in Medical Sciences of Federal University of Ceara, Fortaleza, Ceara, Brazil
| | | | - Polianna Lemos Moura Moreira Albuquerque
- Faculty of Medicine, Post-Graduate Program in Public Health and Medical Sciences of University of Fortaleza, Fortaleza, Ceara, Brazil; Toxicological Information and Assistance Center, Instituto Doutor Jose Frota Hospital, Fortaleza, Ceara, Brazil
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Nongrum SML, Chandel AB, Varma R, Jategaonkar S, Jain M. Hemolytic Anemia and Hypoxic Brain Injury following Mothball Ingestion in a G6PD Nondeficient Infant: A Case Report. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1736477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractMothballs are a common household item used as repellents and deodorizers. They are potential hazards and rare agents of poisoning in children. They are composed mainly of naphthalene, camphor, and 1, 4-dichlorobenzene in varying amounts depending on the manufacturers. It is essential to rule out poisoning by naphthalene in children presenting with hemolysis by eliciting a proper history. Since mothballs are readily available at home, children are drawn to it because of its attractive color and its consumption is a likely possibility. This is a case of ingestional naphthalene poisoning in a 1-year-old glucose 6-phosphate dehydrogenase nondeficient male child who presented with altered sensorium and hemolytic anemia. The child developed methemoglobinemia and sustained hypoxic brain injury. He was successfully managed by oral ascorbic acid, blood transfusion, and requisite supportive treatments. We report a case of naphthalene toxicity with hemolytic anemia and hypoxic brain damage to highlight the possibility of naphthalene poisoning in young children presenting with hemolytic anemia.
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Affiliation(s)
- Saahil Manna L. Nongrum
- Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Anuragsingh B. Chandel
- Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Ravi Varma
- Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Smita Jategaonkar
- Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Manish Jain
- Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
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Paiva JHHGL, Júnior GBS, Magalhaes KDN, Cunha BL, Mota SMB, Daher EDF, Albuquerque PLMM. Acute kidney injury following naphthalene poisoning in children. Nefrologia 2021; 42:S0211-6995(21)00021-7. [PMID: 33632559 DOI: 10.1016/j.nefro.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/31/2020] [Accepted: 11/14/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Geraldo Bezerra Silva Júnior
- Faculty of Medicine, Post-Graduate Program in Public Health and Medical Sciences of University of Fortaleza, Fortaleza, Ceara, Brazil
| | | | | | - Sandra Mara Brasileiro Mota
- Toxicological Information and Assistance Center, Instituto Doutor Jose Frota Hospital, Fortaleza, Ceara, Brazil; Post-Graduate Program in Medical Sciences of Federal University of Ceara, Fortaleza, Ceara, Brazil
| | | | - Polianna Lemos Moura Moreira Albuquerque
- Faculty of Medicine, Post-Graduate Program in Public Health and Medical Sciences of University of Fortaleza, Fortaleza, Ceara, Brazil; Toxicological Information and Assistance Center, Instituto Doutor Jose Frota Hospital, Fortaleza, Ceara, Brazil
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Eskandarani RM, Alghamdi FS. Naphthalene Toxicity in a Three-Year-Old Child Complicated by Severe Hemolytic Anemia and Mild Methemoglobinemia: A Case Report. J Emerg Med 2020; 59:e113-e117. [PMID: 32682642 DOI: 10.1016/j.jemermed.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/13/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Exposure to naphthalene, which is widely used in mothballs, does not usually produce adverse effects. However, naphthalene can be toxic, especially in individuals with underlying conditions such as glucose-6-phosphate-dehydrogenase (G6PD) deficiency. CASE REPORT A 3-year-old boy was brought to our Emergency Department after accidentally ingesting naphthalene mothballs 3 days prior to presentation. Laboratory investigations revealed that he had severe hemolytic anemia and mild methemoglobinemia (6%), which were treated with ascorbic acid and N-acetylcysteine. The patient tested positive for G6PD deficiency after stabilization and completion of his treatment. All provided treatments were administered empirically; test results were available only after the patient was discharged. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Naphthalene exposure is a common pediatric presentation with various complications that can occur in certain high-risk individuals, such as those with G6PD deficiency. Emergency physicians should be aware of this to anticipate and be able to treat worsening toxicity.
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Naphthalene Mothballs Poisoning Leading to Intravascular Hemolysis: A Case Report. J Emerg Med 2020; 58:e1-e3. [PMID: 31744706 DOI: 10.1016/j.jemermed.2019.09.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/22/2019] [Accepted: 09/28/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Naphthalene is widely used in households as an insect repellent, but its poisoning is rare, especially in adults. Naphthalene is a strong oxidant with a pungent smell. CASE REPORT We report a case of a 16-year-old female who ingested three naphthalene mothballs 3 days prior to admission and presented with history of recurrent vomiting, severe pallor, jaundice, and hemoglobinuria. Investigation found severe hemolytic anemia, indirect hyperbilirubinemia, acute kidney injury, and evidence of intravascular hemolysis. Her urine output was normal throughout the course of illness. She was managed conservatively with i.v. fluid, oral ascorbic acid, and blood transfusion. With treatment our patient improved completely and was discharged in hemodynamically stable condition. She is doing fine after further follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physician should keep the possibility of poisoning by an oxidizing agent, such as naphthalene, when a patient presents to the emergency department with rapid onset pallor, jaundice, and hemoglobinuria.
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Abstract
Kerosene poisoning is one of the most common accidental poisoning in children in developing countries due common use of kerosene in house-hold 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 house-hold 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.
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Affiliation(s)
- Surjeet Kumar
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - T K Kavitha
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suresh K Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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