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Mothballs: Not so innocent: A Danger for Seniors
Louis Z G Touyz. Periodontics; Faculty of Dentistry, McGill University, Montreal QC
Canada
Citation and Reference: TOUYZ L.Z.G. (2014) Naphthalene Mothballs: A Silent
Killer. Chapter in: Food Poisoning. Nova Publishers. NY11788 USA. ID 22559. Nova
publishers.com.
Declaration: The author has no conflict of interest to declare
Keywords:
Anaemia, blood-poisoning, carcinogenic, naphthalene, ocular, poisoning, pulmonary-
fibrosis, renal–failure, toxicology, trans-placental.
Outline:
Declaration
Abstract
Background and Introduction
Chemistry, Formula and Properties
Aim
Naphthalene in Biology, Nature and the Universe
Common Uses of Naphthalene
Other uses
Medical Problems and Challenges
Mechanisms and Pathophysiology
Clinical Features
Signs and symptoms
Therapy and Treatment Strategies
Discussion
Sociology and Implications
The Clues
Conclusion
References
…………………………………………………………………………………
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Abstract: (249 words) Mothballs are ubiquitously used to prevent moth-larvae from
damaging valued clothing and furs in storage. Mothballs are made of various chemicals,
the main one being naphthalene. Naphthalene is a bicyclic aromatic compound used
globally for industrial agricultural and commercial uses. It is used for making other
chemicals used as an insecticide, soil fumigant or deodorant. Exposure occurs through
chronic inhalation, skin contact or consumption in the food chain. The lungs and eyes are
susceptible to toxic effects as are the kidney, brain and liver. Lens opacification and
pulmonary histological changes are noted with poisoning, and also depletes glutathione,
inhibits lipid peroxidation, increases DNA fragmentation and produces oxidative stress
through production of superoxide anion and hydroxyl radicals. The ability to protect
against toxic effects of naphthalene by using various anti-oxidants and free radical
scavengers is known. Seniors commonly use insecticides and pesticides at home to
control unwanted household infestations. Extremes of temperatures, dictate that quality
clothing need to be stored over changing weather cycles, to allow more than one seasons
use. Naphthalene is a volatile substance that at room temperature releases a unique
odoriferous gas toxic to moths. Unfortunately naphthalene vapours are also toxic to
human cells and tissues. Various signs and symptoms described hereunder derive from
acute or chronic naphthalene poisoning. Most frequent are haemolytic anaemia, ocular
changes and pulmonary fibrosis. Methods of avoidance and palliative care of poisoning
are discussed, and preventive and sociological strategies are suggested for people to
minimize risks of being affected by mothball poisoning.
2
Background and Introduction:
Naphtha is a collective term for volatile liquid hydrocarbon mixtures that are
inflammable. About 1820 coal-tar naphtha was distilled, (boiled with emanating vapours
cooled and collected) and the resultant substance formed was called naphthalene. Its
pungent odour encouraged people to use it for many purposes including medicinal and
biological applications. Since then many synonyms for naphthalene evolved into
common use: Tar Camphor; White Tar; Moth Flakes; Albocarbon; Dezorator; Moth
Balls; Mighty 150; Mighty RD1; Naphthene and Naphthalene under a variety of different
phonetic spellings area used. It is important to know the chemistry and properties of
naphthalene as the affect handling, storage and other characteristics like storage
temperatures and fires.
Chemistry Formula, Structure and Properties:
Figure 1: Chemical Structure. Naphthalene is composed of 2 joined benzene-like rings,
fused together by sharing common central atoms. The molecular formula is C10H8.
Chemically, naphthalene is classified as a polycyclic aromatic hydrocarbon (PAH) with a
di-benzenoid structure. The positions on the molecule 1,4,5 and 8 are termed alpha
positions, and 2,3,6 and 7 are termed beta positions. The electro-dynamic charges
between the numbered atoms are in constant flux, and the carbon-carbon bonds in
naphthalene are not of the same length. Accordingly, like benzene, naphthalene can
undergo electrophilic aromatic substitution, which allows naphthalene to have more
vigorous chemical reactions than benzene. Naphthalene can bond to other chemicals
without accelerating catalysts to form new compounds. For example naphthalene binds to
chlorine to form 1-chloronaphthalene without a catalyst. The alpha sites react more easily
than the beta sites, and various combinations of add-on chemical produce isomers and a
whole host of differing compounds with unique properties for each. Hydrogenation at
raised temperatures yields other substance like tetralin and decalin, while oxidation with
catalysts yields phthalic acid.
Properties: Molar mass=128.17052g/mol; Naphthalene is a white solid crystalline flake,
easily compressed into a solid. Its density is 1.14g/cm3, will melt 80.26oC, boils at 218oC
and 30mg will dissolve in water at 25oC. Its flash point is 79-87oC and auto-ignition
temperature is 525oC. These properties relate to temperature at 25oC and atmospheric
pressure of 100kPa. [1, 2]
Aim:
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This article appraises naphthalene properties, critiques its patho-biological effects
deriving from accidental/abusive ingestion/incorporation into the human body, and
suggests behavioural modification to minimize hazardous reactions, maximize benefits of
use with correct handling, and suggests possible mechanisms to optimise therapy from
naphthalene intoxication.
Naphthalene in Biology, Nature and the Universe
Universally naphthalene is acknowledged as having biological properties. It occurs
naturally in small amounts by magnolias and by specific types of deer. Some wood
termites (like those found in Formosa) produce it and some claim the naphthalene acts
against other ants, invading fungi and nematode worms. Not only do plants and
arthropods produce naphthalene, but also varieties of fungi like Mucodor albus, and
Muscodor vitigenus. Naphthalene exists in outer space between Cernis 52 and the
constellation Perseus, and traces of it have been extracted from interstellar meteorites
landing on earth. [1, 2]
Common Uses of Naphthalene:
1,4dichlorobenzene is universally used in homes and storages as an insecticide. When
enclosed the solid vaporizes rapidly to toxic lethal levels for adult clothes moths and their
larvae after hatching from eggs. It is not uncommon for people to store clothes in
enclosing linen bags which allows diffusion of the naphthalene into household
atmospheres. Naphthalene is used in agriculture as a fumigant pesticide, and other storage
spaces like attics, storage depositories, costume wardrobes, museum cupboards and
drawers to protect their specimen contents from attack by undesirable insect infestations.
It has been used to kill nematodes (parasitic worms) in livestock. Naphthalene burns with
thick black smoke and this is used in pyrotechnical (fireworks) displays and movies... It
also slows rust formation and bags of it are often kept in toolboxes. Its strong odour is
used in urinals toilets to mask ammoniacal smells. [1, 2]
Other Uses:
Because it is solid at low industrial temperatures, it is used to create porosity in grinding
wheels which are fired way above its melting, flash, and ignition point.
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Naphthalene is also used in the chemical engineering field as a tool on the way to
producing a variety of insecticides and synthetic dyes. Alkyl naphthalene sulfonates are
used to disperse colloidal systems in aqueous media to make granular agricultural
formulations, and processing textiles in fabric industries. It is used widely in processes
for bleaching and dyeing cloth, making pigments, pesticides, rubber processing, and
miscellaneous chemicals and pharmaceuticals. It is used as a plasticiser (dispersant) to
make concrete and plaster board (wallboard and drywall); for synthetic rubbers, tanning
agents, and in making lead-acid battery plates. [1, 2]
Medical Problems and Challenges:
Naphthalene is easily absorbed into the body. Rare cases have been reported through
oral ingestion of the solid. More frequently poisoning occurs from vapours being
absorbed through inhalation, [3, and 4] or dermal via the skin by prolonged contact
through handling. [4, 5, 6, 7]
Ocular contact of naphthalene will cause eye problems, [4] and exposed pregnant
women put their foetuses at risk as naphthalene will cross the placental barrier. [8]
Naphthalene affects the pulmonary cells and induces a chronic inflammation that results
in pulmonary fibrosis. [9]
Red blood cells are particularly susceptible to naphthalene poisoning and anaemia
results, with increased fragility of erythrocytes. [10] Haemoglobin is released in the
serum after release from the imploding erythrocytes. Kidney, [11, 12] liver, [13] heart
[14] and brain tissues react to naphthalene poisoning. Exposure has been associated with
laryngeal and intestinal carcinoma. [15, 16].
It has a characteristic camphor-like smell of tar derived from coals. It is a volatile
flammable solid that vaporizes at room temperature, and is detectable by the human nose
(organoleptically, that is subjectively) at concentrations of 0.08ppm. [17] Workplace
standards of air pollution with naphthalene have been put at a threshold time weighted
value10ppm [18]
Mechanisms and Pathophysiology:
Understanding and controlling the molecule is essential to sustain health. Naphthalene
poisoning promotes oxidative stress in all tissues. [19] It totally inactivates enzymes like
glucose-6 dehydrogenase (G6PDH), and those with inherited deficiency of G6PDH are
particularly susceptible to naphthalene poisoning and develop haemolytic anaemia.
5
Glutathione is a strong anti-oxidant, and because of hereditary erythrocyte instability of
glutathione, naphthalene poisoning with glutathione forms an epoxide metabolite (alpha
naphthol) that mediates erythrocyte haemolysis. [9, 10, 20] Oxidative stress and lipid
peroxidation with sulfur-groups in proteins leads to hepatic necrosis and ocular toxicity.
[12] New borns are susceptible because they cannot conjugate both naphthalene and
bilirubin, leading to neo-natal kernicterus (jaundice). The lens develops cataracts
(precipitated protein). Depletion of glutathione also causes dose-dependant bronchiolar
epithelial necrosis, inflammation and subsequent pulmonary fibrosis with breathing
problems. [9]
Clinical features:
Toxic effects vary widely among patients [4, 21] Naphthalene is not a mammalian
molecule and is incompatible with health.
Ingestion: When introduced into the body it acts as a disruptive poison. 2 grams
ingestion over 2 days will be lethal to a 6 year old child. [3, 22, 23] The lethal dose for
adults is between 5 and 15 grams depending on the weight of the subject [4].
Signs and symptoms:
Presentation: Unexplained headache, abdominal pain, nausea, vomiting, diarrhoea,
fever, and profuse sweating are early features of naphthalene poisoning. Patients may
develop optic neuritis, haemolytic anaemia, jaundice, pallor and hepatic necrosis.
Those with inherited G6DPD deficiency or sickle cell trait are more susceptible to
haemolysis and methmaemoglobinaemia. [22]
Inhalation: Toxicity may be noted and is often encountered after a prolonged period of
exposure. A wide variety of signs and/or symptoms may manifest from chronic exposure
to naphthalene vapours, such as, headaches, bouts of mental confusion, and visual
disturbances [22] chronic inhalation may produce varying degrees of nausea, loss of
appetite, vomiting or disorientation. Delayed intra-vascular haemolysis may occur [4],
and respiratory failure, pulmonary oedema, bouts of pneumonia and dyspnoea,
respiratory distress and respiratory failure may present as a result. [13]
Skin exposure: Continuous handling of naphthalene may produce a dermatitis
characterised by itching, redness, scaling, weeping and crusting of the skin. [22]
Heart: The cardiac effects may show tachycardia and arrhythmias with hyperkalaemia
and possible circulatory failure. [13, 24].
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Blood analysis often includes a rapid fall of the RBC’s count, the haemoglobin, and
haematocrit, and a temporary increase in reticulocytes and normoblasts in the peripheral
blood. Erythrocytes may contain Heinz bodies and show anisocytosis (variation in size)
and poikilocytosis (irregular shapes). Deficiency of G6PDH can be demonstrated with a
specific test (25).
Serum bilirubin is elevated. Consequently urine may vary in colour from reddish brown
to dark brown bark black, and the metabolite alpha naphthol will be found in it. [11].
Eye, Ear, Nose and Throat; Local effects:
Corneal ulceration and cataracts may develop after exposure to naphthalene vapour or
dust. Allergies to naphthalene are also reported but are rare. [4, 25]
Pregnancy: a peculiarity of ‘pica’ (eating unusual abnormal substances as food) may
occur during pregnancy. Pica-sucking of naphthalene in the third trimester has been
reported with toxic haemolytic effects of the mother and baby. Withdrawal allowed for
full recovery of mother and child. [8, 4]
Brain: Many types of insecticides interfere with neuro-transmission and ion channels.
Naphthalene affects the brain and cognitive, pyramidal and extra-pyramidal, cerebellar
functions may be compromised. Mild CNS effects are reversible. [26]
Therapy and Treatment Strategies:
Lens opacification and pulmonary histological changes are noted with poisoning, and
naphthalene also depletes glutathione, inhibits lipid peroxidation, and increases DNA
fragmentation. Naphthalene toxicity produces cellular oxidative stress through production
of superoxide anion and hydroxyl radicals. The ability to protect against toxic effects of
naphthalene by using various anti-oxidants and free radical scavengers has been shown.
[19]. Vit E, VitE-succinate, melatonin, curcumin, various L-cysteine pro-drugs, some
aldose reductase inhibitors and spin-trapping agents, will counter the toxic effects. [19]
Resveretrol is an anti-oxidant found in red wines, grapes and many vegetables.
Resveretrol treatment reverses most biochemical aberrations and histological damages
induced by naphthalene toxicity. Resveretrol inhibits neutrophil infiltration, balance
oxidant-antioxidant status, regulates generation of inflammatory mediators, and
ameliorates oxidative organ injury due to naphthalene toxicity. [27]
Skin and eye exposure: Flush the affected area with lukewarm running water for at least
20 minutes. Wearing impervious gloves when handling the material is essential. [4]
Inhalation: Remove source and separate victim from the source. A thorough assessment
of the respiratory airways, breathing and circulation is demanded. Administer oxygen if
cyanosed and support ventilation. Cardio-pulmonary resuscitation may be indicated.
7
With chronic poisoning frequent assessments of cardiopulmonary health is demanded
with appropriate support to stabilize breathing and cardiac function. [11] A course of
cortisone helps relieve symptoms. [25]
Ingestion: If more than 2 hours has passed gastric lavage is not effective [12]. Activated
charcoal in slurry of water at 1 gram/kg up to 50 grams could prove useful. Fatty foods
and dairy products should be avoided as they promote absorption [4, 12].
Prevention and Removal:
The source of the vapours must be removed including all clothes or foodstuff that may
have been exposed to the vapours. Relocating the victim and aerating their dwelling until
no trace of the naphthalene is detected by smell; this is indicated to ensure stoppage of
the offensive fumes.
Severe anaemia, kernicterus, convulsions, and renal dysfunction demand professional
medical handling, and hospitalization with intense observation and symptomatic
treatments are indicated.
Discussion:
All substances may be poison; it all depends on the dosage received. The weight of
victims, the form in which poisons are administered, and the time over which a poison is
exposed, all impact on the body effects.
Sociology and Implications:
From the wide range of industrial uses outlined above, it is easily possible for many
people to be exposed to naphthalene and its deleterious effects. Children may play with it,
and the ignorant may actually eat it. But by far the most prevalent domestic use is for
protecting clothes and preserving garments or furs against household moths.
For mothballs as naphthalene to be an effective fumigant, clothes should be enclosed in
air-tight plastic bags. This ensures the vapours reach lethal levels for the moths and their
larvae. Once removed, treated garments should be removed from their bags and aired out
in fresh breeze until no camphorous odour can be detected.
People spending prolonged times in confined spaces with high concentrations of
naphthalene vapours are prone to become mysteriously ill. This frequently affects
seniors who hibernate in winter in small apartments, and have laced their accumulated
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expensive garments with naphthalene. Often the garment retainers are not air-tight and
after a short period, the human nose accommodates to the naphthalene smell, and is
tolerated or ignored.
Consequently complex symptoms arise and a medical diagnosis is obfuscated by many
confounding variables and many a physician is flummoxed at the complexity of clinical
findings.[11] Often the diagnosis of chronic naphthalene poisoning is arrived at too late
to be able to implement effective curative therapy, and palliative therapy is all that is
available. This is a challenge for both patient and treating physician.
Chronic naphthalene poisoning through inhalation may produce a sequence of minor but
persistent signs and symptoms. Late onset anaemia, mild jaundice, urinary color changes,
loss of mental acuity and heart problems may all manifest in mild or severe forms.
Chronic poisoning may produce mild signs and symptoms, until threshold levels are
reached, and positive therapeutic interference is indicated. This may demand cardiac,
haematological or ocular therapies depending on which organ is in crisis.
Often the clues from toxicity are vague and obfuscated, but may be picked up in the
presenting anamnesis (Medical History). A patient may report feeling much better after
taking a boat cruise or other outdoor holidays. Others may claim they cannot stand the
winters any more. Some say they breathe more comfortably outdoors but are limited
because of the cold exposure. Friends may note the smell of naphthalene on victims’
clothes, to which the victim may be oblivious. Affected foodstuffs may taste of
naphthalene. If naphthalene poisoning is suspected a urinary test may vary in colour, and
finding the metabolite alpha naphthol in it confirms toxic exposure. [11].
Courtesy, respect, possible ignorance of the deleterious effect and political correctness
prevent friends from reporting or complaining about the offensive odour. Full medical
workups may not be diagnostic or conclusive, and chronic naphthalene poisoning as a
diagnosis may not initially be realized. Patients may develop a cardiac arrhythmia,
anaemia and/or chronic pulmonary fibrosis as a result, and the best chances for
preventive therapy may be missed. Only after symptomatic therapy and relocation to new
lodgings will improvement be noted and a cohesive explanation for the symptoms
realized.
Conclusion
Seniors who have used naphthalene should be more aware of the possible dangers
deriving from its toxic fumes. Everyone should be made aware of the dangers of staying
in an enclosed space without proper ventilation. Proper use and washout aeration of
clothes moth protected by naphthalene are indicated. Mothballs are not so innocent;
they may be a serious danger for seniors
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