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Re: Status epilepticus after topical application of a solution containing camphor

We read with interest the report by Guilbert et al on a case of status epilepticus after topical application of a solution containing camphor (1). For this case of suspected camphor poisoning by transcutaneous absorption, we would like to suggest a few points for discussion.

First of all, the patient developed seizure 72 hours after abdominal massage of a solution containing camphor. It is well known that camphor is rapidly absorbed transcutaneously and cause rapid onset of seizure, usually within the first few hours. Unless there was a reasonable explanation for delayed or continuous absorption, the seizure occurred at 72 hours after the exposure was incompatible with the diagnosis of camphor poisoning.

Besides, a detectable blood camphor level will be very helpful in establishing the causal relationship. Less ideally, the detection of camphor metabolites in urine can be used as an alternative.

Moreover, it would be helpful to know the percentage of camphor in the solution. A single topical use of camphorated solution of low concentration makes camphor poisoning very unlikely.

With respect to the widespread availability of camphor containing products for topical use, and few reports of camphor poisoning through transcutaneous route (2), we believe that camphor poisoning is an unlikely event after normal topical use of camphor containing product.

CK Chan, YC Chan, FL Lau; Hong Kong Poison Information Centre, HKSAR

Correspondence to: Dr CK Chan; ck7477@yahoo.com

Competing interests: None declared

Reference:

1. Guibert J, Flamant C, Hallalel F, Doummar D, Frata A, Renolleau S. Anti-flatulence treatment and status epilepticus: a case of camphor intoxication. Emerg Med J 2007;24:859-860.