DELAYED SYMPTOM ONSET AFTER PEDIATRIC CAMPHOR INGESTION

Introduction : Camphor toxicity after ingestion often causes gastrointestinal symptoms, and in serious cases often involves neurological effects. Symptoms typically occur within 90 minutes of ingestion.  We describe a pediatric patient with an atypical and unusually delayed presentation of camphor toxicity. Case Report : A 4-year-old female presented to the emergency department (ED) via ambulance with altered mental status after a witnessed postictal phase. The child had no history of seizures, no recent surgery or trauma, and initial vitals and physical examination in the ED were normal. The mother reported the child might have ingested an unknown quantity of Vicks® VapoRub approximately 4+ hours prior to the apparent seizure and had been acting normally at daycare in the interim. The girl was alert and maintained her baseline neurologic function with no seizure activity for the duration of her ED encounter, but three hours after ED arrival and seven hours after ingestion, the child began vomiting, with Vicks® VapoRub evident in the emesis. She was given oral ondansetron (Zofran®; GlaxoSmithKline, Middlesex, United Kingdom), was able to per os challenge, and was discharged. Conclusion : This case illustrates the potential variability of presentation in pediatric camphor toxicity, particularly the lack of gastrointestinal upset as an initial symptom