Acute naphthalene toxicity following ingestion of mothballs and ethyl alcohol: a case report

Naphthalene poisoning is an uncommon poisoning due to its pungent smell, taste, insolubility in water, and poor absorption from the gut following exposure to naphthalene-containing compounds such as mothballs. Paradichlorobenzene has been reported to dissolve more quickly in alcohol. Within a period of 48-96 hours following naphthalene mothball exposure patient presents with acute onset of non-bloody bilious vomiting, dark brown urine and watery diarrhoea. We present a diagnostic and therapeutic challenge while treating a 27 years old male admitted to the intensive care unit with features of acute naphthalene-toxicity, methemoglobinemia and acute kidney injury following accidental ingestion of mothballs and ethyl alcohol. His vital signs at the time of intensive care unit admission included fever, tachycardia, and hypotension, and his laboratory workup demonstrates hyperbilirubinemia with indirect predominance, hemolytic anaemia, methemoglobinemia, and renal dysfunction. Treatment options include supportive care, red cell transfusion, ascorbic acid, methylene blue, and N-acetylcysteine. The importance of obtaining a careful history and clinical findings is of paramount importance, especially in making the right diagnosis and a successful outcome largely depends on it.