What is the treatment approach for a patient of unknown age and demographics with no prior medical history who has ingested thinner?

Management of Thinner Ingestion

Immediate Life-Saving Interventions

For thinner ingestion, the priority is supportive care with airway protection and respiratory support, as there is no specific antidote and gastrointestinal decontamination is contraindicated due to aspiration risk. 1

Critical First Steps

• Call emergency services immediately and implement life-support techniques including resuscitation for cardiorespiratory arrest, respiratory support if needed, and left lateral head-down position if the patient is unconscious 1
• Assess and stabilize all vital parameters (airway, breathing, circulation) before any other interventions 2
• Administer supplemental oxygen for respiratory distress or hypoxemia 3
• Provide mechanical ventilation if severe respiratory depression or aspiration pneumonitis develops 3

What NOT to Do

• Do NOT induce vomiting - this is absolutely contraindicated as it increases aspiration risk with hydrocarbon ingestions 2
• Do NOT perform gastric lavage - contraindicated due to high aspiration risk and potential for worsening chemical pneumonitis 2
• Do NOT administer activated charcoal - it has no effect on hydrocarbon absorption and may increase aspiration risk 2
• Do NOT attempt neutralization of the ingested substance 2

Clinical Assessment and Risk Stratification

Key History Elements

• Determine the specific type of thinner ingested (paint thinner typically contains hydrocarbons like toluene, xylene, or mineral spirits), quantity ingested, and time since ingestion 1
• Assess for intentional self-harm - if suspected, immediate emergency department referral is mandatory regardless of dose or symptoms 4
• Identify co-ingestants including alcohol or other substances that may complicate management 1

Physical Examination Priorities

• Respiratory assessment: Look for tachypnea, hyperpnea, dyspnea, cough, or signs of aspiration pneumonitis 4, 3
• Neurological status: Assess for altered mental status, lethargy, confusion, seizures, or coma which can occur with hydrocarbon CNS toxicity 1, 4
• Gastrointestinal symptoms: Check for nausea, vomiting, or abdominal pain 1

Diagnostic Workup

Imaging Studies

• Obtain chest radiograph in all symptomatic patients or those with significant ingestion to evaluate for aspiration pneumonitis, which may appear as bilateral infiltrates, typically in dependent lung zones 3
• Consider chest CT if chest radiograph is equivocal and clinical suspicion for pulmonary complications remains high 3
• Repeat chest imaging at 4-6 hours if initial radiograph is normal but symptoms develop, as radiographic changes may be delayed 3

Laboratory Testing

• Arterial blood gas to assess for metabolic acidosis and hypoxemia 1
• Serum electrolytes to evaluate anion gap and metabolic derangements 1
• Hepatic and renal function tests as some hydrocarbons can cause organ toxicity 1

Supportive Care Management

Respiratory Support

• Monitor oxygen saturation continuously and provide supplemental oxygen to maintain SpO2 >94% 3
• Intubate and mechanically ventilate if respiratory failure develops from aspiration pneumonitis or CNS depression 1, 3
• Use lung-protective ventilation strategies if acute respiratory distress syndrome develops 3

Gastrointestinal Management

• Withhold all oral feedings initially until the patient is stable and aspiration risk is assessed 2
• Provide IV fluids to maintain hydration and electrolyte balance 2

Neurological Monitoring

• Administer benzodiazepines (diazepam) for seizures if they occur 1
• Use sedatives cautiously - diazepam or clorazepate if no respiratory depression risk; otherwise haloperidol for extreme agitation 1

Disposition and Monitoring

Indications for Hospital Admission

• Any symptomatic patient with respiratory symptoms, altered mental status, or gastrointestinal symptoms requires emergency department evaluation and likely admission 4
• Asymptomatic patients with significant ingestion should be observed for at least 4-6 hours for development of delayed respiratory or neurological symptoms 1, 4
• All intentional ingestions require psychiatric evaluation and admission until acute suicide risk has subsided 1

Follow-Up Monitoring

• Serial chest radiographs if aspiration pneumonitis develops, typically at 24-48 hours to assess progression or resolution 3
• Monitor for delayed complications including chemical pneumonitis (which can worsen over 24-72 hours), hepatotoxicity, or renal injury 3

Common Pitfalls to Avoid

• Do not assume absence of symptoms means no toxicity - respiratory and neurological symptoms can be delayed up to 6-12 hours after ingestion 1, 4
• Do not discharge asymptomatic patients too early - observe for minimum 4-6 hours as aspiration pneumonitis may have delayed presentation 3
• Do not overlook psychiatric evaluation in cases of intentional ingestion, as these patients have high risk of repeat suicide attempts 1
• Do not use ipecac syrup under any circumstances - it is obsolete and increases aspiration risk 1