A CASE SERIES OF EUCALYPTUS OIL-INDUCED SEIZURES
Eucalyptus oil (EO) is an essential oil which has been used as a traditional remedy in upper respiratory tract infection. It contains approximately 90% cineole and is readily available worldwide in over-the-counter cough drops, liniments, toothpaste, mouthwashes, cold preparations, and hair lice remover. EO-induced adverse drug reaction is rare in both adults and children. The signs and symptoms of EO poisoning are CNS depression, hypotension, tachycardia, epigastric pain, nausea, vomiting, and contact dermatitis. Symptom onset is usually rapid and resolves within 24 h. We report the case series of four adult patients with EO-induced seizure in India, who inhaled EO for common cold and presented to the critical care with single first attack of generalized tonic-clonic seizures. On further evaluation, none of them had a family background of seizures/febrile seizures. EEG and brain MRI were found to be normal in all patients. All the patients were managed with anti-epileptic drugs and standard supportive care. All medical practitioners should be aware of the toxic effects of EO, a common OTC medication used in Indian households. Warning labels may be attached on EO comprised products.
2. Ryvlin P. Update on seizure disorders. Curr Opin Neurol 2019;32:181-2.
3. Chen HY, Albertson TE, Olson KR. Treatment of drug-induced seizures. Br J Clin Pharmacol 2016;81:412-9.
4. Jun YS, Kang P, Min SS, Lee JM, Kim HK, Seol GH. Effect of eucalyptus oil inhalation on pain and inflammatory responses after total knee replacement: A randomized clinical trial. Evid Based Complement Alternat Med 2013;2013:502727.
5. Dhakad AK, Pandey VV, Beg S, Rawat JM, Singh A. Biological, medicinal and toxicological significance of Eucalyptus leaf essential oil: A review. J Sci Food Agric 2018;98:833-48.
6. Waldman N. Seizure caused by dermal application of over-the-counter Eucalyptus oil head lice preparation. Clin Toxicol 2011;49:750-1.
7. Flaman Z, Pellechia-Clarke S, Bailey B, McGuigan M. Unintentional exposure of young children to camphor and eucalyptus oils. Paediatr Child Health 2001;6:80-3.
8. Low T. Bush Medicine: A Pharmacopoeia of Natural Remedies. Australia: Angus & Robertson; 1990.
9. Barr A, Knight T, Barr A, Andrews M, Alexander V. Traditional Bush Medicines: An Aboriginal Pharmacopoeia. California: Greenhouse Publications; 1988.
10. Maiden JH. The Forest Flora of New South Wales. Vol. 7. Sydney, Australia: Government Printer; 1908.
11. Whitman BW, Ghazizadeh H. Eucalyptus oil: Therapeutic and toxic aspects of pharmacology in humans and animals. J Paediatr Child Health 1994;30:190a-1.
12. Esmonde-White HP. Eucalyptus oil poisoning. Ind Med Gaz 1898;33:107.
13. Foggie WE. Eucalyptus oil poisoning. Br Med J 1911;1:359-60.
14. Mathew T, Kamath V, Kumar RS, Srinivas M, Hareesh P, Jadav R, et al. Eucalyptus oil inhalation-induced seizure: A novel, underrecognized, preventable cause of acute symptomatic seizure. Epilepsia Open 2017;2:350-4.
15. Webb NJ, Pitt WR. Eucalyptus oil poisoning in childhood: 41 cases in South-East Queensland. J Paediatr Child Health 1993;29:368-71.
16. Sitaraman R, Rao G. A pediatric case of accidental Eucalyptus oil poisoning from New Delhi, India: Emergency measures, historical context, and implications for practice. Cureus 2019;11:5734.
17. Fan V, Anand S. The Health Workforce in India. Geneva: World Health Organization 2016.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.