Menthol poisoning: MedlinePlus Medical Encyclopedia

P Menthol is used to add peppermint flavor to candy and other products. It is also used in certain skin lotions and ointments. This article discusses menthol poisoning from swallowing pure menthol.
P This article is for information only. Do NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

T Poisonous Ingredient
P Menthol can be harmful in large amounts.

T Where Found
P Menthol may be found in:
- Breath fresheners
- Candy
- Cigarettes
- Cold sore medicines
- Cough drops
- Creams and lotions to relieve itching
- Gum
- Inhalants, lozenges, or ointments to treat nasal congestion
- Medicines to treat sore mouth, throat, or gums
- Mouthwashes
- Ointments to treat aches and pains (such as Ben-Gay, Therapeutic Mineral Ice)
- Peppermint oil
P Other products may also contain menthol.

T Symptoms
P Below are symptoms of menthol poisoning in different parts of the body.
P BLADDER AND KIDNEYS
- Blood in the urine
- No urine output
P LUNGS
- Rapid breathing
- Shallow breathing
P STOMACH AND INTESTINES
- Abdominal pain
- Diarrhea
- Nausea and vomiting
P HEART AND BLOOD
- Pounding hearbeat (palpitations)
- Rapid heartbeat
P NERVOUS SYSTEM
- Convulsions
- Dizziness
- Tremor
- Unconsciousness
- Unsteady walking

T Home Care
P Seek medical help right away. If the menthol is in an ointment or cream, wipe away any that is on the skin or in the eyes. Flush the area with water for several minutes. Call poison control for further help.

T Before Calling Emergency
P Have this information ready:
- The person's age, weight, and condition
- The name of the product (and ingredients and strength, if known)
- Time it was swallowed (or got in the eyes or on skin)
- Amount swallowed (or got in the eyes or on skin)

T Poison Control
P Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.
P This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

T What to Expect at the Emergency Room
P Take the container with you to the hospital, if possible.
P The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated.
P The person may receive:
- Activated charcoal
- Breathing support, including tube through the mouth into the lungs, and breathing machine (ventilator)
- EKG (electrocardiogram, or heart tracing)
- Chest x-ray
- Fluids through a vein (by IV)
- Laxative
- Medicine to reverse the effects of the menthol and treat symptoms
- Tube down the windpipe and lungs (bronchoscopy) to look for burns and other damage
- Tube through the mouth into the stomach to empty the stomach (gastric lavage)

T Outlook (Prognosis)
P How well someone does depends on how much menthol they swallowed and how quickly they receive medical treatment. The faster medical help is given, the better the chance for recovery. Swallowing such poisons can have severe effects on many parts of the body.
P However, pure menthol is not easy to get. The menthol found in many over-the-counter products is usually watered down and mixed with other ingredients. Therefore, how well a person does also depends on the other ingredients in the product.

T References
P Allen CM, Camisa C. Oral disease. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 72.
P Gold Standard Drug Database drug monograph. Menthol. Philadelphia, PA: Elsevier Clinical Solutions; 2010. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2530?scrollTo=%23top. Accessed November 3, 2015.
P Maypole J, Woolf AD, Donovan JW. Essential oils. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 101.
P Murray MT. Mentha piperita (peppermint). In: Pizzorno JE, Murray MT. Textbook of Natural Medicine. 4th ed. St. Louis, MO: Elsevier; 2013:chap 105.
P Nair B. Final report on the safety assessment of mentha piperita (peppermint) oil, mentha piperita (peppermint) leaf extract, mentha piperita (peppermint) leaf, and mentha piperita (peppermint) leaf water. Int J Toxicol. 2001;20 Suppl 3:61-73. PMID: 11766133 www.ncbi.nlm.nih.gov/pubmed/11766133.

T Review Date 10/13/2015
P Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

