Eucalyptus oil: therapeutic and toxic aspects of pharmacology in humans and animals

Eucalyptus Oil-Induced Seizures in Children: A Single-Center Prospective Study

Objective

Eucalyptus oil (EO) is known to have proconvulsant properties. EO is present in many over-the-counter preparations and used orally or topically to treat many ailments. In this study, we seek to describe clinical features, neuroimaging, and electroencephalographic findings and follow up outcome in children with eucalyptus oil-induced seizures (EOIS).

Materials and methods

This was a single-center prospective observational study, conducted at a tertiary care hospital from South India over a period of two years. Children (up to 18 years of age) with a first afebrile seizure or breakthrough seizures with preexisting epilepsy and with a recent exposure to EO were included. Data from all the children including demographic data, exposure to EO, mode of exposure, time to onset of seizures in relation to exposure, duration of seizure, type of seizure, investigations, and antiepileptic drug therapy were noted. All the patients were followed up for recurrence of seizures for six to nine months. 

Results

During the study period of two years, a total of 17 children met the inclusion criteria, with a median (range) age of 3.75 years (23 - 150 months) and 10 (59%) were male. Only one patient had breakthrough seizures and all other 16 children had a first episode of seizure. All the children had generalized tonic-clonic seizures with median duration of three minutes (30 sec - 30 minutes). The median (range) interval between EO exposure and the onset of seizures was 20 minutes (10 - 120 minutes). All the children had taken EO drops orally mixed in either water or milk in different amounts. All the patients' brain neuroimaging was normal. All the patients had normal electroencephalography except for four children. Only five patients were treated with antiepileptic drugs for two weeks and one patient with preexisting epilepsy was continued on the same antiepileptic drug. None of the patients had a recurrence of seizures during the follow-up period of six to nine months.

Conclusion 

EOIS is an underrecognized and rare entity of seizures in children. EOIS can occur as first seizures or as breakthrough seizures in preexisting epilepsy patients. Despite the previous case reports in the literature quoting the seizurogenic potential of EO, this awareness is lacking in both clinicians and parents. We also recommend clinicians inquire about exposure to EO while approaching a child with first afebrile seizures or breakthrough seizures, which can prevent unnecessary investigations and long-term antiepileptic drug therapy.

Eucalyptus Oil-Induced Seizures in Children: Case Reports and Review of the Literature

Objective  Eucalyptus oil (EO)-induced seizures (EOIS) in children is a less recognized entity and a rare cause of acute symptomatic seizures. The purpose of this review outlines the clinical features and outcomes of EOIS with observed cases. Patients and Methods  We identified three pediatric patients with EOIS who were treated at Prathima Institute of Medical Sciences, Karim Nagar, India. Results  Seizures were developed in three children within 15 to 25 minutes after the ingestion of EO. All the children have taken EO first time and all have the first episode of seizures. One child had status epilepticus. Neuroimaging and electroencephalogram were normal. Two children were treated with antiepileptic drugs for 2 weeks. All the children were recovered within 2 days and none of them had a recurrence of seizures. Conclusion  EOIS is an underrecognized and rare entity. The knowledge or awareness of EOIS among health care professionals can prevent unnecessary investigations and long-term antiepileptic drug therapy.

A Pediatric Case of Accidental Eucalyptus Oil Poisoning from New Delhi, India: Emergency Measures, Historical Context, and Implications for Practice

Eucalyptus oil (EO) and EO containing products are readily available worldwide over the counter as topical nasal decongestants, rubefacients, anti-pyretics, and anti-inflammatory agents. However, EO is poisonous when orally ingested, or otherwise internally administered, resulting in serious outcomes such as seizures, vomiting, drowsiness, and even death. In this case report, we describe emergency measures adopted in a suspected case of EO ingestion by a 17-month-old female infant. It was found that stomach washes with normal saline followed by the oral administration of ranitidine to prevent vomiting restored and maintained normalcy over a 24-hour period. We situate our experience within the Indian context and recommend that pediatricians and healthcare workers routinely and explicitly warn parents about the serious consequences of the incorrect usage of substances containing essential oils in general and EO in particular.

Chemical composition and biological activities of leaf and fruit essential oils from Eucalyptus camaldulensis

The chemical composition of the essential oils from the leaves and fruit of Eucalyptus camaldulensis grown in Mersin, Turkey was analyzed using gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS) techniques. The biological activities (antibacterial and antifungal) were examined using the agar well diffusion method. The main leaf oil constituents were p-cymene (42.1%), eucalyptol (1,8-cineole) (14.1%), α-pinene (12.7%) and α-terpinol (10.7%). The main constituents of the fruit oil were eucalyptol (1,8-cineole) (34.5%), p-cymene (30.0%), α-terpinol (15.1%) and α-pinene (9.0%). Our results showed that both types of oils are rich in terms of monoterpene hydrocarbons and oxygenated monoterpenes. The leaf and fruit essential oils of E. camaldulensis significantly inhibited the growth of Gram-positive (Staphylococcus aureus and Bacillus subtilis) and Gram-negative (Escherichia coli and Streptococcus sp.) bacteria (p<0.05). The oils also showed fungicidal activity against Candida tropicalis and C. globrata. Leaf essential oils showed more activity than fruit essential oils, probably due to the higher p-cymene concentration in leaves.

Side-effects of complementary and alternative medicine

Complementary and alternative medicine are increasingly used to diagnose or treat allergic diseases, and numerous studies have reported benefits of this type of medicine. This article presents a review of the literature on risks of these methods. The potential sensitizing capacity of numerous herbal remedies may lead to allergic contact dermatitis and more rarely to IgE-mediated clinical symptoms. Mechanical injuries may be observed following acupuncture leading to pneumothorax, cardiac tamponade or spinal injury. Infectious complications after acupuncture include hepatitis and bacterial endocariditis. Organ toxicity has been observed associated with various herbal preparations involving the liver, kidneys, and the heart. Some herbs may have cancerogenic properties. Severe nutritional deficiencies can occur in infants and small children given strict alternative diets, resembling 'kwashiorkor'. Finally, among other miscellaneous adverse effects, adulteration with steroids, and herbal and drug interactions are discussed. The pattern of side-effects is similar to that observed by the use of conventional medicine. Therefore, caution may be justified using both conventional and unconventional methods. Only if the benefit is proven and the side-effects are established, should a given method be chosen.

Adverse effects of herbal drugs in dermatology

Herbal treatments are becoming increasingly popular, and are often used for dermatological conditions. Thus dermatologists should know about their potential to cause adverse events. This review is aimed at addressing this area in a semisystematic fashion. Some agents, particularly Chinese herbal creams, have been shown repeatedly to be adulterated with corticosteroids. Virtually all herbal remedies can cause allergic reactions and several can be responsible for photosensitization. Some herbal medicines, in particular Ayurvedic remedies, contain arsenic or mercury that can produce typical skin lesions. Other popular remedies that can cause dermatological side-effects include St John's Wort, kava, aloe vera, eucalyptus, camphor, henna and yohimbine. Finally, there are some herbal treatments used specifically for dermatological conditions, e.g. Chinese oral herbal remedies for atopic eczema, which have the potential to cause systemic adverse effects. It is concluded that adverse effects of herbal medicines are an important albeit neglected subject in dermatology, which deserves further systematic investigation.

Topical eucalyptus oil poisoning

Eucalyptus oil is well documented as being extremely toxic if ingested. We report a case of systemic eucalyptus oil toxicity from topical application. A 6-year-old girl presented with slurred speech, ataxia and muscle weakness progressing to unconsciousness following the widespread application of a home remedy for urticaria containing eucalyptus oil. Six hours following removal of the topical preparation her symptoms had resolved, with no long term sequelae.