Management of Nail Polish Ingestion
Do not rinse the mouth with water or saline after nail polish ingestion unless specifically directed by poison control—instead, immediately contact the Poison Help hotline (800-222-1222) for guidance, as administering anything by mouth may be harmful. 1
Immediate First Steps
Contact poison control immediately before taking any action, as the appropriate management depends entirely on the specific product ingested 1:
- Call 800-222-1222 (Poison Help hotline) in the United States, or 112 in Europe 1
- Have the product container available to identify the exact ingredients 1
- Note the time of exposure and approximate amount ingested 1
Critical Safety Warning: Do NOT Give Water or Milk
Do not administer anything by mouth—including water, saline, or milk—unless specifically advised by poison control, as this may cause harm 1:
- There is insufficient evidence that dilution with water or milk provides any benefit 1
- Possible adverse effects include inducing vomiting and aspiration 1
- This recommendation carries a Class III level of evidence (harmful) 1
Why This Matters: Product Identification is Critical
The toxicity of "nail polish remover" varies dramatically based on ingredients, making product identification essential before any intervention 2, 3, 4:
- Traditional nail polish remover contains acetone, which causes CNS/respiratory depression but is less immediately dangerous 5
- Artificial nail removers may contain acetonitrile (metabolizes to cyanide with delayed severe toxicity), nitroethane (causes methemoglobinemia), or gamma-butyrolactone (causes coma and cardiorespiratory collapse) 2, 3, 6
- These products are easily confused but have vastly different toxicities and management requirements 3, 4
When to Activate Emergency Services
Activate EMS immediately if the patient exhibits any life-threatening signs 1:
- Sleepiness or altered mental status 1
- Seizures 1
- Difficulty breathing 1
- Vomiting 1
- Cyanosis (blue discoloration) 2
What NOT to Do
Avoid these interventions unless specifically directed by poison control 1:
- Do not administer activated charcoal (Class IIb evidence—not shown to be beneficial and may cause harm) 1
- Do not administer syrup of ipecac (Class III evidence—harmful, causes intractable vomiting and delays advanced care) 1
- Do not attempt to induce vomiting 1
Common Pitfalls
The most dangerous error is assuming all "nail polish removers" are the same 3, 4:
- Acetonitrile-containing products cause delayed onset of severe cyanide toxicity (potentially 12+ hours after ingestion) 3, 4
- Initial symptoms may be mild or absent, leading to false reassurance 3, 4
- Blood cyanide levels can reach lethal range even with small ingestions 3
- One reported case involved a 16-month-old found dead the morning after ingestion when the product was mistakenly assumed to be acetone 3