Background: Naphthalene ingestion and skin or inhalational exposure (accidental or deliberate) is an
under-recognized cause of a severe toxidrome in regions where it is commonly used (e.g., mothballs in households).
Methods: This review is an update for the clinicians to understand the pharmacology, clinical features, laboratory
evaluation, and treatment for naphthalene toxicity. High-quality literature for the past eight decades was collected
and reviewed in this article. Several landmark articles were reviewed using PubMed, EMBASE Ovid, and the Cochrane
Library, which have essential implications in the current toxicology practice.
Results and Conclusion: Naphthalene toxicity usually occurs abruptly and leads to acute hemolysis, methemoglobinemia,
renal failure, respiratory depression, and acute brain dysfunction that are difficult to manage. The toxicity is
more marked in patients with G6PD deficiency and associated with high morbidity and mortality. The management
should mainly focus on high-quality supportive care; however, severe methemoglobinemia (>20-30%) requires specific
therapy with intravenous methylene blue. Methylene blue is a highly effective agent but contraindicated in
severe G6PD deficiency.