Naphthalene is a chemical widely used in industrial and sometimes household chemicals—and mothballs. It's also used to produce dyes, plastics, lubricants, fuels, and resins.
While a rare form of poisoning, naphthalene toxicity from ingestion, inhalation, or skin contact has caused severe red blood cell destruction, blood disorders, organ damage, and more.
Understanding naphthalene toxicity is vital to avoid such occurrences. This article provides a comprehensive overview of naphthalene poisoning, including its symptoms, treatment, prevention, and long-term complications, to educate individuals on its health effects.
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What is Naphthalene?
Naphthalene may be more prevalent in your surroundings than you may think.
Chemical Properties and Uses
Naphthalene is a hydrocarbon and insecticide derived from crude oil or coal tar. It's a white, crystalline solid with a distinct aromatic odor that smells like mothballs or tar. This substance is produced when fuel, tobacco, or wood is burned.
In 1948, the United States Department of Agriculture registered naphthalene as a pesticide. This substance is released from incomplete combustion and is present in cigarette smoke, motor vehicle exhaust, forest fires, and other natural events.
It's often used to produce dyes, resins, plastics, lubricants, fuels, leather goods, pesticides, and mothballs to control insects in indoor storage spaces.
Some naphthalene products are also designed to repel bats, squirrels, rodents, and other animals. Deodorant balls in public toilets may contain naphthalene, too.
Sources of Exposure
There are numerous sources of naphthalene exposure, including:
- Pest-repellent exposure or ingestion
- Manufacturing products containing naphthalene
- Clothing, diapers, or bedding stored with naphthalene mothballs
- Toilet bowl deodorizers
- Coal tar production
- Wood preserving
- Burning coal, oil, or wood
- Wildfire repellents
- Tanning
- Ink or dye production
- Cigarette smoke
- Some household products (paints, glues, automotive fuel treatments, etc.)
- Mothball use disorder (intentionally ingesting mothballs or inhaling its fumes)
Air concentrations of naphthalene in cities are usually about 0.18 parts per billion (ppb). This toxin can enter the body by breathing in contaminated air or more concentrated fumes.
Ingesting contaminated water or food is also a source of naphthalene exposure, though this is not common. After ingestion, naphthalene can damage the body's red blood cells.
Understanding Naphthalene Poisoning
Naphthalene uniquely affects the body and can cause severe harm.
How Naphthalene Affects the Body
Large doses of naphthalene negatively affect the body by damaging or destroying red blood cells (hemolytic anemia), preventing them from carrying oxygen. This can lead to organ damage.
The breakdown of red blood cells can occur after ingestion, inhalation, or skin contact with naphthalene. This toxin is absorbed, distributed, metabolized, and excreted by the body.
Target organs naphthalene may affect include the skin, eyes, blood, kidneys, liver, and central nervous system—often causing significant damage.
Following exposure to this chemical, the body metabolically activates naphthalene, and different tissues produce metabolites that cause site-specific toxicities. The metabolite alpha-naphthol is linked to hemolytic anemia after ingestion or extreme dermal or inhalation exposure.
Susceptibility is greater in individuals with a glucose 6-phosphate dehydrogenase (G6PD) enzyme deficiency.
Naphthalene or products formed by its breakdown can be measured in blood, urine, breast milk, fat, and feces.
Acute vs. Chronic Exposure
The symptoms and health outcomes often experienced after naphthalene poisoning depend on whether the exposure is acute (short-lived) or chronic (long-lasting). Symptoms range in severity from mild to severe and debilitating (sometimes permanent).
Symptoms of Naphthalene Poisoning
The symptoms experienced during naphthalene poisoning may include:
Early Signs and Symptoms
Early symptoms of naphthalene toxicity include:
- Abdominal pain
- Diarrhea
- Nausea
- Vomiting
- Blackish-brown urine
- Headaches
- Drowsiness
- Malaise (feeling ill)
- Confusion
- Fever
Gastrointestinal issues might not appear until two days after exposure to naphthalene.
Severe and Long-term Symptoms
Over time, the following additional symptoms might develop:
- Hemolytic anemia
- Kidney damage
- Liver damage
- Jaundice
- Neurological effects
- Coma
- Convulsions
- Low blood pressure
- Increased heart rate
- Low urine output
- Shortness of breath
- Pain with urination
- Eye damage
- Profuse sweating
- Blood in the urine
- Dermatitis
- Cataracts
- Nasal inflammation
- Lung damage
- Dementia
The symptoms you experience depend on the type of exposure (skin, inhalation, or ingestion) you encounter.
Special Considerations for Vulnerable Populations
Babies, pregnant women, children, and individuals with preexisting conditions are population groups that are more vulnerable to naphthalene poisoning.
Newborns are particularly susceptible to hemolysis following naphthalene exposure, and fetuses can develop hemolytic anemia after their mother's exposure to naphthalene.
Men and people of Mediterranean or African descent are more likely to have a G6PD enzyme deficiency, an inherited trait making them more vulnerable to naphthalene poisoning.
Diagnosing Naphthalene Poisoning
Diagnosing naphthalene poisoning may consist of:
Medical Evaluation and Testing
A discussion of patients' symptoms, medical history, medications, lifestyle, and exposure to potentially toxic levels of naphthalene is essential.
Diagnostic testing can measure naphthalene levels in the urine, feces, blood, breast milk, or fat cells.
It's also essential to assess temperature, blood pressure, breathing rate, and other vital signs and complete a physical exam.
Additional diagnostic tests include a chest X-ray, an electrocardiogram (EKG), or a bone marrow biopsy.
Differential Diagnosis
Differential diagnosis helps distinguish naphthalene poisoning from conditions with similar symptoms, including:
- Acquired methemoglobinemia
- Thallium poisoning
- Mercury poisoning
- Arsenic poisoning
- Other chemical toxicities
- Vitamin deficiencies
- Neurocognitive disorders
Treatment and Management
It's vital to effectively treat and manage naphthalene poisoning to reduce the risk of long-term complications.
Medical Treatments
Depending on the type of exposure, immediate treatments for naphthalene poisoning include:
- Forced vomiting
- Laxatives
- Forced alkaline diuresis
- Activated charcoal
- Oxygen or other airway/breathing support
- Ventilator in extreme cases
- Supportive intravenous (IV) nutrients and hydration
- Blood transfusion
- Vitamin supplementation or injections
- Amino acid (N-acetyl cysteine) supplementation
- Hemodialysis
- Medications that treat symptoms or reverse effects of poisoning
Therapies should be personalized based on the severity of symptoms experienced and diagnostic testing results. Recovery could take several weeks or longer.
Integrative and Functional Approaches
Holistic treatments and lifestyle modifications can support recovery after naphthalene poisoning. Examples include proper hydration, good nutrition, and avoidance of further toxin exposure.
Dietary supplements may be beneficial to combat any nutrient deficiencies and strengthen the immune system.
Prevention of Naphthalene Poisoning
Reducing the risk of naphthalene poisoning involves:
Safe Handling and Storage Practices
Adhering to safety guidelines can minimize exposure risks.
The Centers for Disease Control and Prevention (CDC) offers general guidelines, such as preventing skin and eye contact, washing skin that's been exposed to chemicals, removing contaminated clothing, and wearing an air-purifying mask.
Store naphthalene-containing products in their sealed containers in a safe area out of the reach of children.
Regulatory Standards and Exposure Limits
The United States Environmental and Protection Agency (EPA), CDC, and International Agency for Research on Cancer (IARC) help set regulatory standards and exposure limits for naphthalene.
The EPA, World Health Organization (WHO), and IARC classify this chemical as a possible human carcinogen (potential cancer-causing agent).
Public Health Initiatives and Education
Community programs and other public health initiatives should educate people about naphthalene exposure and poisoning to raise awareness of this concern, maintain high safety standards, and reduce the risk of accidental exposure and poisoning.
Long-term Effects and Recovery
Potential long-term health issues resulting from prolonged naphthalene exposure include cataracts, eye damage, dementia, peripheral neuropathy, other neurological conditions, and organ damage–particularly kidney damage.
These chronic health impacts are sometimes reversible. Recovery from naphthalene poisoning may take several weeks (or longer).
Rehabilitation and Support
Rehabilitation and support after naphthalene poisoning involves long-term management of complications, such as kidney damage and neurological problems.
It's also vital to adopt healthy habits and avoid future exposure by wearing protective equipment and avoiding mothballs and other naphthalene products.
Case Studies and Personal Stories
Many real-life examples of naphthalene poisoning develop because of mothball inhalation or ingestion.
One case study involved a 33-year-old Sri Lankan woman who had ingested 15 naphthalene mothballs and presented with intravascular hemolysis. She was successfully treated with adequate hydration and a blood transfusion.
Another case of a 42-year-old woman with mothball use disorder developed dementia and other neurological problems.
Her treatment included substance use disorder treatments and other psychiatric care, vitamin supplementation and injections, and avoidance of mothballs. After abstaining from mothballs for a year, her cognitive functioning improved.
A third case involved a 15-year-old boy who accidentally ate mothballs, thinking they were candy. He was glucose-6-phosphate dehydrogenase (G6PD)-deficient and suffered from acute kidney injury and intravascular hemolysis.
His successful treatment consisted of oxygen inhalation, a blood transfusion, forced alkaline diuresis, hemodialysis, vitamin C supplementation, and N-acetyl cysteine supplementation.
Disclaimer: The case studies and personal stories presented in this section are for informational purposes only and do not constitute medical advice. Individual experiences with naphthalene exposure may vary, and treatment outcomes depend on various factors, including medical history and healthcare interventions. If you or someone you know has been exposed to naphthalene or is experiencing health concerns, seek immediate medical attention. Always consult a qualified healthcare professional for diagnosis, treatment, and guidance regarding chemical exposures and their potential effects.
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Key Takeaways
- While rare, naphthalene poisoning is a serious concern—particularly among babies, children, pregnant women, and individuals with a deficiency in the glucose-6-phosphate dehydrogenase (G6PD) enzyme.
- Naphthalene toxicity can cause vomiting, diarrhea, other gastrointestinal issues, hemolytic anemia, neurological conditions, organ damage, and more.
- Treatment options are medications, activated charcoal, hemodialysis, blood transfusions, hydration and vitamin IVs, oxygen therapy, laxatives, and forced vomiting.
- Prevention measures include wearing protective clothing when handling products containing naphthalene, avoiding exposure entirely, and recognizing the early symptoms of toxicity.
- Naphthalene poisoning awareness and taking proactive measures to prevent exposure to this harmful substance is critical.
- Share this article with family and friends, subscribe to our newsletter for more health insights, and leave comments with your experiences or questions below.
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