What is the management approach for thinner ingestion?

Management of Thinner Ingestion

For thinner (paint thinner/hydrocarbon solvent) ingestion, do NOT induce vomiting or perform gastric lavage—observe asymptomatic patients at home and refer only those with persistent symptoms (coughing, choking, respiratory distress) or intentional ingestion to an emergency facility. 1, 2

Initial Assessment and Triage

Immediate Contraindications

• Never induce vomiting with ipecac or any other method 2, 3
• Never perform gastric lavage 2, 3
• Never attempt neutralization of the ingested substance 2
• Activated charcoal is not indicated and has no effect on hydrocarbon ingestion 2, 3

Risk Stratification by Intent

Intentional self-harm or malicious administration:

• Refer immediately to an acute care facility regardless of amount ingested or symptoms 4
• This applies to all suspected suicide attempts or deliberate poisoning 4

Accidental ingestion:

• The vast majority (65%) remain completely asymptomatic throughout observation 5
• An additional 34% develop mild transient symptoms that resolve quickly 5
• Only approximately 1% develop significant complications requiring intervention 5

Home Observation Criteria

Patients who can be safely observed at home: 5

• Completely asymptomatic at time of poison center contact
• Mild symptoms that resolve quickly (within 1-2 hours)
• Accidental ingestion with reliable caregiver for monitoring
• No respiratory symptoms (coughing, choking, wheezing)

Observation period:

• If asymptomatic for 6 hours post-ingestion, significant complications are unlikely to develop 4
• Follow-up calls may be indicated depending on specific circumstances 4

Indications for Emergency Department Referral

Refer immediately if any of the following are present: 2, 5

• Persistent or severe symptoms (continuous coughing, respiratory distress, altered mental status)
• Respiratory symptoms suggesting aspiration (wheezing, tachypnea, hypoxia)
• Hematemesis or bloody diarrhea
• Persistent vomiting beyond initial episode
• Any intentional ingestion or suspected self-harm 4

Initial Management (First 60 Minutes)

Dilution only:

• Dilute with water or milk within the first 60 minutes if patient is alert and able to swallow 2
• This is the ONLY intervention recommended before medical evaluation 2

Stabilize vital parameters:

• Assess and support airway, breathing, circulation 2
• Monitor for respiratory compromise from aspiration 5

Hospital-Based Management (When Indicated)

Diagnostic evaluation for symptomatic patients: 1

• CT scan with IV contrast is superior to endoscopy for assessing transmural injury 1
• Endoscopy only if CT unavailable, contraindicated, or findings uncertain 1
• Chest imaging if respiratory symptoms present 5

Supportive care: 2, 6

• Maintain NPO status initially 1
• Assess fluid and electrolyte balance 2
• Symptomatic intensive care measures as needed 6
• Monitor for development of chemical pneumonitis 5

Common Pitfalls to Avoid

• Do not assume all symptomatic patients need hospitalization—mild transient vomiting or diarrhea after hydrocarbon ingestion is common and does not require referral if symptoms resolve quickly 5
• Do not perform "routine" gastric decontamination—the risk of aspiration during induced vomiting or lavage exceeds any potential benefit 2, 3
• Do not discharge patients with persistent respiratory symptoms—chemical pneumonitis can develop and requires medical monitoring 5
• Do not use small nasogastric tubes for lavage even if lavage is considered necessary (which it rarely is)—they are nonproductive and cannot be advocated 3

Special Considerations

Pregnant patients:

• Use the same management approach as non-pregnant patients 4
• Calculate risk based on pre-pregnancy weight if dose calculations needed 4

Psychiatric evaluation:

• Mandatory for all intentional ingestions prior to discharge 1
• Long-term psychiatric follow-up important to prevent recurrence 1