A 2-year old presents with a chief complaint of accidental mothball ingestion 2 days ago per his mother. He appears pale and has had a couple episodes of vomiting. He has a history of G6PD deficiency. What are your immediate concerns? (scroll down for answer)

 Answer: Hemolytic anemia in the setting of naphthalene toxicity

Naphthalene toxicity pearls

• Naphthalene is a polycyclic aromatic hydrocarbon found in mothballs
• Metabolized via the liver
• Symptoms can present 2-3 days after initial ingestion and include fatigue, weakness, pallor, and jaundice; may lead to methemoglobinemia
• Patients with G6PD deficiency at higher risk for hemolysis and may need exchange transfusion
• Important labs to send: CBC, LDH, haptoglobin, liver function panel, methemoglobin level, possibly a blood gas depending on how critically ill they are
• Assess for co-ingestions
• Toxicology consult and admission

References:

Sudakin, D. “Naphthalene Mothballs: Emerging and Recurring Issues and their Relevance to Environmental Health.” Accessed via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850774.

Kundra, Tanveer Singh et al. “Naphthalene Poisoning Following Ingestion of Mothballs: A Case Report.” Journal of Clinical and Diagnostic Research : JCDR9.8 (2015): UD01–UD02. PMC. Web. 15 Mar. 2018.