US EPA

5019503 

Journal Article 

Abstract 

Severe hemolytic anemia due to ingesting naphthalene-containing moth repellent balls 

Wills, B; Willis, D; Bullock, A; Cumpston, K 

2018 

1 

Clinical Toxicology
ISSN: 1556-3650
EISSN: 1556-9519 

56 

10 

1082-1082 

English 

WOS:000449536500296 

http://://WOS:000449536500296
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Background: The vast majority of pediatric mothball ingestions result in minimal toxicity. In 2016 the National Poison Data System reported only three major outcomes from naphthalene. We report a case of severe hemolytic anemia after ingestion of moth repellent balls containing naphthalene.
Case report: A 14-month-old male with history of sickle cell trait on no daily medications, presented to the emergency department with lethargy. His mother reported finding him eating naphthalene-containing mothballs 2 d prior. He initially vomited twice, then developed irritability, lethargy and fever over the following 24 to 48 h. Fragments of moth balls were noted by the mother in his diaper. On arrival, vital signs included: temperature of 38.9; HR 178 bpm; BP 102/82 mmHg; respiratory rate 40; SpO2 95%. Physical exam revealed mild distress, crying, tachypnea and scleral icterus. Heart and lung exam was normal. Initial laboratory studies included hemoglobin 3.6 g/dl (10.9 g/dl 20 d earlier), indirect bilirubin 1.8 mg/dl, LDH 3331 u/l (0–85), haptoglogin 43 mg/dl (35–200) and methemoglobin of 6%. The patient was treated with a single transfusion of packed red blood cells and supportive care. Methylene blue was not used. Additional workup while hospitalized included peripheral blood smear and G6PD. He recovered fully and was discharged after a 2-d hospitalization.
Case Discussion: Hemolysis and methemoglobinemia have been reported from exposures to naphthalene but is rare. Toxicity can be more severe in those with G6PD deficiency, infants, sickle cell disease or sickle cell trait. Methylene blue was not used due to the combination of low methemoglobin level and concern for further hemolysis.
Conclusion: This was a case of severe hemolytic anemia due to ingestion of naphthalene moth balls, likely magnified due to his concomitant sickle cell trait. 

Mothball; naphthalene; hemolysis 

North American Congress of Clinical Toxicology (NACCT) Abstracts 2018