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Paper text:
nail polishes and nail polish removers may contain a variety of hydrocarbon - based solvents , while nail adhesives usually contain various acrylic ester monomers .
the chemical n , n - dimethyl - p - toluidine is a chemical commonly found in artificial fingernail solutions .
its oxidation metabolite phenyl hydroxylamine is presumably one of the most potent chemical producers of methemoglobin . accidentally drinking small amounts of acetone / nail polish remover
although there are so many reported case of nail polish removal poisoning in the western literature , but so far no such case reported in asia .
a 13-month - old male child presented to us with history of ingestion of small volume of nail polish remover 2 h back and followed by he has started vomiting and gradually becoming lethargic .
after admission , the child was kept under observation and we observed that gradually he became cyanosed , restless , and more lethargic .
he had no other significant history . on general physical examination , at the beginning though he had no cyanosis or any significant observation .
but , after about 1 h he found to have cyanosis . on systemic examination , he had only lethargy and irritability without any sign of respiratory distress .
we investigated the child and he had all the hematological and biochemical parameters within normal limit .
but , he had low oxygen saturation ( 85 - 87% ) in pulse oxymeter and simultaneously taken arterial blood gas showing po2 : 157 mm of hg with mildly increased lactate ( 1.9 mmol / lit ) and the ph and other parameter was within normal limit . as there was low spo2 with increased po2
, so we suspected that he must be having methemoglobinemia and further investigated for serum methemoglobin level and serum g6pd level .
the serum methemoglobin level came out to be 72% and g6pd found to be in the normal range .
the child was discharged after 1 day with the final diagnosis of toxic methemoglobinemia due to nail polish remover poisoning .
when an infant presents severe cyanosis which is not associated with respiratory distress , methemoglobinemia should always be suspected .
blood from the heel sticks is chocolate - brown and does not become pink when exposed to room air . in the absence of cyanide level determinations , lethargy ,
vomiting , seizures , and the lack of normal venous blood hemoglobin desaturation are clues to cyanide toxicity .
diagnosis can be confirmed by excluding other causes of cyanosis and by spectrophotometric analysis of blood for methemoglobin .
when methemoglobin levels reach 70% or more , the patient will collapse and become comatose and may die .
treatment with methylene blue can be complicated by the presence of underlying enzyme deficiencies , including glucose-6-phosphate dehydrogenase deficiency .
health care providers should not confuse the potentially highly toxic acetonitrile - containing cosmetics , particularly false - fingernail removers , with less - toxic acetone - containing fingernail - polish removers . this potential confusion between acetone and acetonitrile poisoning
is compounded by the initial similarity of their early features , including vomiting , lethargy , slurred speech , ataxia , stupor , coma , and respiratory depression .
delayed vomiting , although not typically a major clinical indicator of most cases of cyanide poisoning , may be important in alerting health care providers to acetonitrile toxicity in exposed children .
however , vomiting is common from many causes and is not sufficient by itself to dictate the administration of a cyanide antidote in the absence of other supporting evidence of cyanide toxicity from history and clinical laboratory studies .
sudden death is possible in some nail polish poisoning cases . the health care provider will measure and monitor the patient 's vital signs , including temperature , pulse , breathing rate , and blood pressure .
the patient may receive activated charcoal if the patient arrives immediately after swallowing the poison , gastric lavage , oxygen , if needed .
we wish to draw attention to the potential toxicity of acetone containing nail polish removers and the need for appropriate labeling of product packaging .
children are most susceptible to accidental exposure of common household substances and one of the common household substances is nail polish remover . we are presenting a case of accidental ingestion of nail polish remover with lethal methemoglobinemia ( serum methemoglobin level-72% ) . 
 this patient was treated successfully with injection methylene blue . 
 however , even small amounts can be dangerous to children , so it is important to keep this and all household chemicals in a safe place