Hematuria, an unusual systemic toxicity, in formic acid ingestion: a case report (original) (raw)
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The Journal of Emergency Medicine, 2013
Background: Formic acid (FA), a common industrial compound, is used in the coagulation of rubber latex in Kerala, a state in southwestern India. Easy accessibility to FA in this region makes it available to be used for deliberate self-harm. However, the literature on intentional poisoning with FA is limited. Study Objectives: To determine the patterns of presentation of patients with intentional ingestion of FA and to find the predictors of mortality. A secondary objective was to find the prevalence and predictors of longterm sequelae related to the event. Methods: We performed a 2-year chart review of patients with acute intentional ingestion of FA. Symptoms, signs, outcomes and complications were recorded, and patients who survived the attempt were followed-up by telephone or personal interview to identify any complications after their discharge from the hospital. Results: A total of 302 patients with acute formic acid ingestion were identified during the study period. The mortality rate was 35.4% (n = 107). Bowel perforation (n = 39), shock (n = 73), and tracheoesophageal fistula (n = 4) were associated with 100% mortality. Quantity of FA consumed (p < 0.001), consuming undiluted FA (p < 0.001), presenting symptoms of hypotension (p < 0.001), respiratory distress (p < 0.001), severe degree of burns (p = 0.020), hematemesis (p = 0.024), complications like metabolic acidosis (p < 0.001) and acute respiratory distress syndrome (p < 0.001) were found to have significant association with mortality. The prevalence of esophageal stricture (n = 98) was 50.2% among survivors and was the most common long-term sequela among the survivors. Stricture was significantly associated with hematemesis (p < 0.001) and melena (p < 0.001). Conclusion: This study highlights the magnitude and illeffects of self-harm caused by a strong corrosive, readily available due to very few restrictions in its distribution. Easy availability of FA needs to be curtailed by enforcing statutory limitations in this part of the world. Patients with hematemesis or melena after FA ingestion may be referred for early dilatation therapy in a setting where emergency endoscopic evaluation of all injured patients is not practical.
International Journal of Head and Neck Surgery, 2014
Background: Formic acid (FA) being pungent, odorless, easily available and consumed for suicidal purposes and the dilute form being colorless and odorless is consumed accidentally. Accidental ingestion is rare and deliberate self-harm is very painful and violent which has been a rare modality of committing suicide but for these areas where it is easily available. Materials and methods: This a retrospective case series analysis study 14 patients with acute formic acid poisoning. There were 14 patients, with 3 females and 11 males. The average age was 35.5 years, with the average in males being 34.9 and 37.6 in females. Thirty milliliter were consi dered as cutoff range as diluted/undiluted FA below 30 ml were managed in our institution and 30 ml+ were referred to higher toxicology speciality care. Results: Act of deliberate self-harm was seen in 11 cases (78.5%) and accidental ingestion in three cases (21.5%). All had orofacial burns, 4 had mild hematemesis and 3 severe hematemesis with impending renal complications. All the stabilized and referred cases were no further evaluated for follow-up. Facial burns and contracture needing cosmetic correction was seen in three cases, while corneal and lid scarring seen in two cases while a case of esophageal stricture with lower GIT and renal complications were seen in one case. Conclusion: Formic acid poisoning is uncommon, and limited literature review is available with fewer protocols laid. So, immediate management of this corrosive poisoning with supportive measures reduces the mortality drastically. Serial upper gastrointestinal imaging diagnose stricture earlier and cosmetic reconstruction helps in facial scarring and contractures.
Accidental acid ingestion in children: case series and literature review
International Surgery Journal, 2023
Accidental acid ingestion is more common in children as compared to adults. It is an important late morbid complication of the upper gastrointestinal tract. 1 The severity of injury usually mild in children because they have tendency to vomit out ingested content immediately. In Indian population alkali ingestion is more common because it is cheaper and easily available in house as toilet cleaners. 2 Immediate complications of corrosive ingestion occur in approximate 10% of cases which are oesophageal perforation, laryngeal trauma, bleeding, and fistula formation but stricture is a delayed complication. Acid ingestion usually cause injury around the antrum and pylorus because of acid stasis which leads to stricture and cause gastric outlet obstruction. Management depending upon severity and location of strictures and options are endoscopic dilatation, gastrojejunostomy, Billroth-1 partial gastrectomy, Heineke-Mikulicz pyloroplasty, Finney pyloroplasty and Antroplasty. 3-5 We wish to report six cases of gastric outlet obstruction due to acid ingestion and five patients managed by Heineke-Mikulicz pyloroplasty and one patient by gastrojejunostomy. CASE SERIES Case 1 A 7 years male child presented to emergency with upper abdominal pain and non-bilious vomiting. Child not tolerating oral feed and vomit after each feed. H/o battery water ingestion 20 days ago. No h/o fever, cough and breathing difficulty. On examination child was lethargic, thin built, mild tenderness present in left hypochondrium and lumbar region. Routine blood examination within normal limit. Barium swallow and meal follow through shows stenosis of gastric antrum with outflow obstruction (Figure 1). In upper GI endoscopy, oesophagus was normal, stomach contracted, pyloric opening not seen, scope could not be negotiated beyond pylorus, duodenum not seen. On exploratory laparotomy stomach was dilated, antral wall thickened approx. 3 cm, oedematous and friable. Antral lumen was narrow with fibrotic mucosa. Posterior wall of antrum was fibrotic and thinned out. Subsequently, we conducted Heineken Mikulicz pyloroplasty with feeding jejunostomy was done. The patient was discharged on eleventh postoperative day uneventfully.
Corrosive injury to the stomach due to acid ingestion
The American surgeon, 1985
Ingestion of acid often causes severe damage to the stomach. Ingestion of alkali, however, usually injures the esophagus and spares the stomach. Early complications of acid ingestion, e.g., massive gastric hemorrhage or perforation, are unusual. The absence of severe symptoms in most patients soon after ingestion of acid is often misleading. Gastric outlet obstruction is a common late result and may develop following an asymptomatic interval. The authors' experience with three patients with severe complications following ingestion of acid is presented. The initial treatment, as well as the surgical management, are discussed.
Caustic ingestions including Acids & Alkalians agents are the serious injuries for GI tract. Particularly esophagus and stomach. Those frequently in young children(below five years old).Severe caustic injuries have been reported from developing countries. Those common in males than females and often occurred accidental in children. Method Our study was descriptive(retrospective)by extraction of some data of our patients(with caustic ingestion)from their files including(age-gender-acid or alkalian-severety of injury-out come). And compared them with other studies. Results In this period(Dec 2010 to Dec 2015) we admitted 252 children with intoxication in our ward.16 cases of them were caustic ingestions.(6.34%)(.8 females&8males).Because of incomplete of two files of them, its out of our study. Then we had been 14 files(8females and 6males).The mean age of females was 4.25&males3.75 years. According to the PH of agents separated them to strong or weak acids and strong or weak alkalians. Ingestion of strong acids common than alkalians. According to the endoscopic findings, The 8 cases of them had esophagitis grade 2a,2bor3a. Because of we had not pediatric gastrologist,our patients were referred to another hospital. Then unfortunately we had not any information about there out come. The whole of our patients with oropharyngial. Signs and symptoms(including edema,erytema, droling, respiratory distress, erosion and ulcer)associated with severe findings in GI tract. Conclusion Caustic ingestions are the serious injuries in GI tract particularly in children. Those often in young children(below five years old).According to the our study, Our patients unfortunately ingested strong acids, and for treatment and long time following of them must to be a pediatric gastrologist in this wards.
Kinetics and toxic effects of repeated intravenous dosage of formic acid in rabbits
British journal of experimental pathology
Adult male rabbits were injected i.v. with I00 mg buffered formic acid per kg body weight daily for 5 days with 24 h between the doses. The fifth dose was labelled with '4C-formic acid. Rabbits were killed I, 2 and 20 h after the last injection. The highest formic acid concentrations were found one hour after the fifth dose. Total formic acid concentrations were always higher than radiometrically measured. The maximum concentrations of formic acid in brain, heart, kidney and liver were roughly similar to the concentration which inhibits half of the cytochrome oxidase activity in vitro. Histological studies clearly demonstrated the histotoxic changes at cellular level. Calcium deposits were detected in all organs of the injected rabbits. They were absent in control animals. It seems that the formic acid metabolism is slow and that it may cause sufficient hypoxic acidosis to allow the calcium influx and cellular damage.
Accidental Corrosive Acid Intoxication - a Case Report
International journal of medical toxicology and forensic medicine, 2014
Background : Acute poisonings with corrosive substances cause serious chemical injuries to upper gastrointestinal tract, the most common site being the oesophagus and the stomach. The degree and extent of damage depends on several factors like the type of substance, the morphologic form of the agent, the quantity, and the intent. In the acute stage, perforation and necrosis may occur. Injury to UGI tract due to ingestion of acidic corrosive substances is common in India. Acute corrosive intoxications constitute a major problem in clinical toxicology since the most commonly affected population are the young with psychic disorders, suicidal intent and alcohol addiction. Case Report: We report a fatal case of accidental corrosive acid ingestion with a brief review of literature. Conclusion: Ingestion of a corrosive substance can produce severe injury to the gastrointestinal tract and can even result in death. Stringent legislation is necessary in developing countries to curtail unrest...
An autopsy based study of corrosive acid poisoning and its medico-legal aspects -A case report
Indian Journal of Forensic and Community Medicine, 2023
The study is of ingestion of corrosive substances and its medico-legal aspects. Corrosive refers to any chemicals (strong acids and alkalis) that dissolve and destroy the structure of an object. Corrosives corrode and damage the tissue on contact. In dilute form it acts as an irritant. Strong acid reacts violently with water and generates heat and fire. In our study, corrosive acid ingestion and its deteriorating & devastating effects ranging from signs, symptoms and internal damage leading to death have been analyzed. Here we discuss a case of an adolescent girl who ingested a corrosive substance at home, was rushed to hospital in a gasping stage where resuscitated treated and finally succumbed to death. Correlating the autopsy findings, medical treatment records and the scene of incidence was crucial to determine medico-legal aspects. Keywords: Corrosive acids, Perforation, Spillage, Peritonitis, Coagulation necrosis, Medico legal.