Acetone‐free nail polish remover pads: toxicity in a 9‐month old

Acetone‐free nail polish removers are widely used and perceived as safe. However, an ingredient γ‐butyrolactone (GBL) is readily converted into γ‐hydroxybutyrate (GHB), which has well‐known toxic effects. A previously well 9‐month‐old child was found sucking on two nail polish remover pads. The period the pads were in his mouth did not exceed 1 min. Within 15 min, he vomited and became drowsy; after 30 min he was in a coma with a Glasgow Coma Score (GCS) of 3. Oxygen was administered while he was transported to the emergency department by ambulance.

On arrival at the emergency department, 60 min post ingestion, his GCS had improved to 6. He had hypotension, bradycardia and was in shock. Blood gases showed a mild respiratory acidosis. Biochemistry was normal. He responded well to fluid resuscitation. By 90 min, his GCS had recovered to 12. This progressed to hyperalertness and extreme giddiness that persisted for several hours. His pupils, which were initially constricted and poorly reactive, became more responsive. The child made a complete recovery within 8 h of ingestion.

This child developed coma and cardiorespiratory compromise after briefly sucking on two nail polish remover pads. We presume that this was due to rapid absorption of ingredients of this product through buccal, sublingual and oral routes. Conditioning nail polish remover pads contain the following as principal ingredients: GBL (84%), butoxyethanol (10%), diethylene glycol (2%), panthenol (1%) and propylene glycol (1%). GBL is rapidly metabolised to GHB, which causes a pattern of toxicity similar to that seen here.

Another case of poisoning and severe toxicity in a 15‐month‐old child who sucked on an identical product was reported. He became comatose with cardiorespiratory collapse requiring ventilation and intensive care, but made a complete recovery.¹ When contacted after the incident, the manufacturers responded: “as a cautionary measure, action has been taken to reformulate the products to add a material called Bitrex that makes it more unpalatable and further reduces the risk of unintentional ingestion, a keep out of reach of children message is to be included on the packaging”.

Acetone‐free nail polish removers are widely used and were perceived as safe. Our case highlights the dangers of GBL‐containing products when ingested.