LAUSR

with reactivity to stimuli. She regained consciousness and was extubated successfully on day 15. She scored 28/30 on mini-mental state examination performed on day 16. She transferred to a psychiatric bed on day 18 and was commenced on escitalopram. On day 20, she was transferred to a hospital closer to her home. Eucalyptus oil contains 62–89% w/w 1,8-cineol. It has antimicrobial, fungicidal, insecticidal/insect repellent, herbicidal, acaricidal and nematocidal effects and is weakly genotoxic. Toxicity has occurred from small volume ingestions and also with topical therapy. It is excreted through skin, lung, gut and kidneys. From 1 January 2004 to 31 December 2014, there were 6085 unique exposures to eucalyptus oil reported to the New South Wales Poisons Information Centre. Of these, 77% were accidental, 15% were therapeutic errors and 5% were intentional. Most patients (57%) were aged 0–14 years, 33% were aged 14–74 years, 4% were aged 75 years and over. Twenty per cent of exposures required hospitalisation. Clinical features reported included vomiting, ataxia, seizures, miosis, sedation, respiratory depression requiring intubation and aspiration pneumonitis. Fatal cases of eucalyptus oil have been recorded with small quantities of ingestion including a boy of 10 years who died 15 min after ingestion of 16 mL, with vomiting and respiratory distress and blood found in the pleural cavity on post mortem examination. In one adult case of eucalyptus oil overdose referred to in the same report, a 34-year-old man took about 15 mL and developed rapid loss of consciousness progressing to coma and eventual respiratory failure. Death in adults has occurred with ingestion of as little as 4–480 mL of eucalyptus oil and is reported as common after ingestion of 30 mL or more; recovery has been reported after 23 mL in an untreated adult and 120–220 mL in a treated adult. Seizures are common in children but rare in adults. Renal failure may occur after the ingestion of large volumes. Management is supportive. This case represents the largest overdose of 100% eucalyptus oil in the literature. In spite of this, she made a full recovery. Modern supportive care in an intensive care setting can result in good outcomes even in massive eucalyptus oil overdose.