Thinner Ingestion (Hydrocarbon Poisoning)

Infanta Amalaselvi T^1*, Malathi M², Sonya Mercy Anbu³, Ruby Ravichandran⁴

¹Staff Nurse ER, Maa Kauvery Hospital, Trichy, Tamil Nadu

²Incharge ER, Maa Kauvery Hospital, Trichy, Tamil Nadu

³Assistant Nursing Superintendent³, Maa Kauvery Hospital, Trichy, Tamil Nadu

⁴Senior Deputy Nursing Superintendent Maa Kauvery Hospital, Trichy, Tamil Nadu

*Correspondence

Introduction

Thinner poisoning is a form of chemical toxicity that occurs when paint thinner or solvent substances are inhaled, ingested or absorbed through the skin. These products contain volatile organic chemicals that can rapidly affect the nervous system and vital organs. Exposure may lead to symptoms ranging from dizziness and nausea to severe respiratory distress, organ failure or even death, making thinner poisoning a serious medical emergency.

Case presentation

A 6years old male child was brought with alleged history of accidental thinner ingestion of approximately 20-25ml at home followed by one episode of vomiting that was non-bilious, non-blood stained, with no mucus or food particles. There was a history of up-rolling of eyes not associated with tonic-clonic movements of the limbs initially then child was taken to nearby clinic where he was treated with medication. He was drowsy with minimal response to pain full stimuli and was referred to another hospital. As the child continued to be unresponsive to pain, he was referred to our hospital for further management

On arrival at the emergency room, the child was drowsy but hemodynamically stable, with tachypnea, hypoxemia, SPO₂ 88%, Temp 101.2⁰Bilateral subcostal retractions, and reduced air entry over the left lung. Chest X-ray suggested aspiration pneumonitis, more prominent on the left, following thinner ingestion. The child was kept nil per oral, started on oxygen, and shifted to the PICU for close monitoring. Lung POCUS revealed left basal consolidation with bilateral lower-lobe B-lines. With supportive care, antibiotics, steroids, and respiratory support, the child showed steady clinical and radiological improvement. Respiratory support was weaned within 48 hours, feeds were gradually resumed, and the child became alert, afebrile, and stable. Residual left lower-zone consolidation persisted on follow-up POCUS, but the child tolerated oral feeds well and was discharged in stable condition with appropriate medications and advice

Sign & Symptoms

Headache
Dizziness
Fatigue
Nausea and vomiting
Abdominal pain
Drowsiness
Seizure
Tachycardia
Tachypnoea
Bilateral subcostal retraction
Decreased air entry

Investigation

Results of investigations are as follows:

Investigation	Result
Hb	14g/dl
WBC count	3040cells/cumm
Platelet count	375000Lakhs/mm3
PCV	42.6%
Sodium	137mmol/L
Potassium	3.36mmol/L
Chloride	104mmol/L
Bicarbonate	18.8mmol/L
Procalcitonin	13.5ng/ML
pH	7.28
Pco2	45mmHg
Po2	64mmHg
Hco3	21.1mmol/L
Lactate	5.9mmol/L

Blood gas showed -Mild Lactic Acidosis

Fig (1): Chest X- ray – Aspiration pneumonitis

Diagnosis

Thinner ingestion – (Hydrocarbon Poisoning)
Chemical Pneumonitis

Management

Emergency and critical care

Rapid assessment done on airway, breathing, and circulation
Maintenance of oxygenation
Vital signs monitored continuously
Maintained intake, and output chart strictly

Neurological Monitoring

Hourly neurological checks done
Monitored for seizure recurrence

Respiratory care

Administered oxygen (High flow nasal cannula)
Chest physiotherapy given
Monitored respiratory rate, pattern, effort, and air entry regularly

Nutrition and fluid balance

Hydrated adequately with IV fluids and liquid diet

Family education and Emotional support

Periodical update given on child’s condition, prognosis
Counseled regarding neurological recovery timeline

Nursing management

Adhered hand hygiene technique & moments throughout the hospitalization
Closely monitored for neurological deterioration
Managed airway, monitored hemodynamic of the child
Assisted with regular Nebulization as prescribed
Prevented complications such as aspiration by providing fowlers position, infection by adhering hospital infection control policies and pressure injuries by frequent positioning and back care
PLABSI (Peripheral Line Associated Bloodstream Infection) bundle care followed
CAUTI (Catheter Associated Urinary Tract Infection) bundle care followed
Nutritional support provided as per the advice of dietician
Provided psychosocial support to the family

Pharmacotherapy given,

IV Fluids
Ceftriaxone
Clindamycin
Dexamethasone
Pantoprazole
Ondansetron
Mucaine gel
paracetamol
Prednisolone

Outcome

The patient showed gradual clinical improvement following early diagnosis and appropriate treatment.
Vital signs stabilized, and there were no further episodes of respiratory distress, hemodynamic instability, or altered sensorium.
Gastrointestinal and neurological symptoms were resolved completely.
Laboratory investigations, including renal and liver function tests, returned to normal, with no evidence of systemic toxicity or organ damage.
No delayed complications occurred, and invasive interventions were not required.
The patient tolerated oral intake well, was weaned off supportive care, and discharged in stable condition.
Family education on poison prevention and safe chemical storage was provided.

Condition at discharge

GCS 15/15
Vital stable
No recurrent seizure
Tolerated oral feeds well
No respiratory distress
Well Hydrated
Good urine output

Discharge Advice

Diet advice -clear fluids, soft diet (Rice, Banana, Apple, Curd)
Medication advice

S.no	Drug Name	Strength	Route	Relationship with meal	Frequency	Duration
1	Tab. Cefodoxime	100 mg	Oral	After food	BD	5 Days
2	Tab. Pantoprazole	20 mg	Oral	Before food	OD	5 Days
3	Tab. Prednisolone	20 mg	Oral	After food	OD	2 Days and then
		10 mg	Oral	After food	OD	2 Days
4	Syp. Mucaine Gel	-	Oral	After food	10ML-0-10ML	5 Days
5	Tab. Tramadol	-	Oral	After food	2/3 -0-2/3	2 Days

Conclusion

This case highlights the importance of early recognition and prompt supportive care in thinner poisoning. Timely stabilization, close monitoring, and appropriate symptomatic treatment led to complete recovery without any systemic or pulmonary complications. The patient showed steady improvement, with normalization of vital signs and laboratory parameters, and was discharged in a stable condition. Preventive counseling on safe storage and handling of industrial solvents was provided. Early intervention and vigilant supportive care are crucial in reducing complications and ensuring a good prognosis in children who consume hydrocarbon cases.

Thinner Ingestion (Hydrocarbon Poisoning)

Thinner Ingestion (Hydrocarbon Poisoning)

Infanta Amalaselvi T1*, Malathi M2, Sonya Mercy Anbu3, Ruby Ravichandran4

Nightingale Journals

Infanta Amalaselvi T^1*, Malathi M², Sonya Mercy Anbu³, Ruby Ravichandran⁴