title: Acetone-free nail polish removers: are they safe?
abstract: BACKGROUND
  The following case report highlights the dangers of acetone-free nail polish remover products which are widely regarded as safe.
  
  
  METHODS
  A 15-month-old presented with coma and cardiorespiratory collapse after sucking on Boots Conditioning Nail Polish Remover Pads, which was complicated by features of upper airway obstruction, bilateral pneumothoraces, and pneumomediastinum. The child required intubation and ventilation for 5 days along with full supportive management before making a complete recovery. The clinical features in this case resemble those of poisoning due to gamma butyrolactone, the principal component of this nail polish remover. Gamma butyrolactone is rapidly metabolized to gamma hydroxybutyrate on ingestion, a compound whose toxicity is well recognized. Package labeling gave no indication of the potential toxicity of its components.
  
  
  CONCLUSIONS
  We wish to draw attention to the potential toxicity of gamma butyrolactone containing nail polish removers and the need for appropriate labeling of product packaging. Since alternative products are available, these products should be removed from the market.
authors: Department of Endocrinology and Diabetes and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia. justin.brown@mcri.edu.au
authors: Justin J
authors: JJ
authors: Brown
authors: Charith S
authors: CS
authors: Nanayakkara
mesh_terms: D015107:4-Butyrolactone / Q000506:poisoning*; D001919:Bradycardia / Q000139:chemically induced; D003358:Cosmetics / Q000506:poisoning*; D005260:Female; D006801:Humans; D007223:Infant; D011030:Pneumothorax / Q000139:chemically induced / Q000628:therapy; D012121:Respiration, Artificial; D012997:Solvents / Q000506:poisoning*; D013352:Subcutaneous Emphysema / Q000139:chemically induced / Q000628:therapy
chemical_list: D003358:Cosmetics; D012997:Solvents; D015107:4-Butyrolactone