What is the treatment for a child who has ingested paint thinner?

Management of Paint Thinner Ingestion in Children

Do not give anything by mouth—no water, milk, or activated charcoal—and immediately contact Poison Control (1-800-222-1222) while activating EMS if the child shows any concerning symptoms. 1, 2

Immediate Actions (First 5 Minutes)

Critical "Do Not" Actions:

• Do NOT induce vomiting or give ipecac - this is contraindicated and causes harm without benefit 1, 2, 3
• Do NOT give water or milk for dilution - no human studies show benefit, and this may trigger vomiting and aspiration 1, 2
• Do NOT administer activated charcoal unless specifically directed by Poison Control 1, 3

Required Actions:

• Call Poison Control Center immediately (1-800-222-1222) for specific guidance on systemic toxicity management 1, 2
• Activate EMS immediately if the child exhibits altered mental status, seizures, respiratory difficulty, or vomiting 1, 2
• Remove all contaminated clothing to prevent continued exposure, avoiding self-contamination 4, 2

Expected Clinical Toxicity Profile

Paint thinner ingestion causes multi-organ toxicity requiring intensive monitoring:

Central Nervous System Effects:

• Drowsiness, dizziness, agitation, or coma 1
• Seizures may occur 2

Respiratory Complications:

• Chemical pneumonitis from aspiration 5
• Respiratory depression and tachypnea 6

Cardiovascular Manifestations:

• Tachycardia and altered peripheral perfusion 2
• Potential for sudden cardiac death from arrhythmias 7

Hematologic Complications:

• Methemoglobinemia - a critical complication causing cyanosis with chocolate-brown blood 6, 8
• Look for cyanosis with discrepancy between pulse oximetry and arterial blood gas results 8

Other Organ Systems:

• Gastrointestinal: sore throat, mucosal irritation 1
• Renal failure and rhabdomyolysis 5, 7
• Polyneuropathy 5

Hospital Management Priorities

Airway and Breathing:

• Children have higher minute ventilation and less fluid reserves, making them more susceptible to toxic effects 2
• Early intubation may be required for severe cases 7

Methemoglobinemia Treatment:

• Methylene blue is first-line therapy for severe methemoglobinemia 8
• High-dose vitamin C (ascorbic acid) is a safe alternative if methylene blue is unavailable - one case report documented successful treatment of 46.4% methemoglobin level 8
• Oxygen therapy is essential 6

Supportive Care:

• Continuous cardiac monitoring for arrhythmias 7
• Fluid resuscitation for shock (hypotension, prolonged capillary refill ≥2 seconds, altered consciousness) 2
• Monitor for rhabdomyolysis with serial creatine kinase levels 5

Critical Pitfalls to Avoid

• Do not delay EMS activation while attempting home interventions 2
• Do not assume small ingestions are safe - as little as 45-50 mL can cause severe complications 5
• Do not miss methemoglobinemia - the key diagnostic clue is cyanosis with mismatch between pulse oximetry and arterial blood gas analysis 8
• Do not overlook hypothermia risk during decontamination in pediatric patients 2
• Do not underestimate delayed toxicity - multi-organ failure can develop over days, with death reported 11 days post-exposure 7

Prognosis and Monitoring Duration

Paint thinner ingestion can be fatal even with small amounts, and survivors of large ingestions (200 mL) have been reported with aggressive supportive care 5. Multi-organ toxicity may manifest over 11 days, requiring prolonged intensive monitoring 7. Complete recovery is possible with early recognition and appropriate supportive care 6, 5.