Formalin: nephrotoxic teratogen?

Formaldehyde is an extensively used chemical; its ill effects have been of concern. Its nephrotoxic effects in laboratory animals and carcinogenic effects on humans are well established. We report of a pregnant woman with a normal ongoing pregnancy with a morphologically normal fetus. She was exposed to high doses of formaldehyde through inhalational route in the second trimester. Six weeks later she was found to have severe oligohydramnios with dysplastic fetal kidneys and fetal ascites. The various known causes for this problem reported in the literature are discussed. Based on the discussion the author has drawn a conclusion that the fate of the fetus reported can be attributed to transplacental nephrotoxic effect of formaldehyde. Previously two cases of malformations have been reported but this appears to be the first case of transplacental nephrotoxicty of formaldehyde.

[Accidental intravenous injection of formaldehyde]. / Omylkowe dozylne podanie roztworu formaliny.

BACKGROUND: Formaldehyde can be found in operating theatres where it is used for preservation of biopsied tissues. Several misuse accidents have been described previously.We present a case where formaldehyde was mistakenly injected intravenously. CASE REPORT: A 33-year-old man, scheduled for excision of a knee meniscus under spinal anaesthesia, was to receive an intravenous antibiotic at the end of surgery. The attending anaesthesiologist received a vial of cephazolin, marked with the patient name from a scrub nurse and injected its contents intravenously. Immediately after injection, the patient complained about strong pain at the site of injection and started to cough.The vial was checked again and a piece of meniscus preserved with 4% formaldehyde was found inside. It was intended to be offered to the patient on departure. The possible amount offormaldehyde injected was 400 mg (a lethal dose has been described as 12 g). The patient, despite the lack of cardiorespiratory failure, was intubated, ventilated and dialysed for six hours, and then extubated without further consequences. His biochemical markers remained in the normal range. Based on the case as described, the possible medico-legal consequences of poor organisation and preventive measures are discussed.

Fatal large-volume mouthwash ingestion in an adult: a review and the possible role of phenolic compound toxicity.

OBJECTIVE: To describe a case of fatal mouthwash ingestion and review possible sources of toxicity. DESIGN: Case report. SETTING: Veterans Administration Medical Center. PATIENT: Single patient with massive mouthwash ingestion. MAIN RESULTS: This patient was a 45-year-old man who developed cardiovascular collapse and multiorgan system failure following a massive ingestion of mouthwash (almost 3 liters). His presentation was remarkable for a profound anion-gap metabolic acidosis and a significant osmolar gap. No other co-ingestants were identified, and he expired despite full supportive care including dialysis and mechanical ventilation. An autopsy failed to identify any other cause of death. Nonalcoholic ingredients of this mouthwash are phenolic compounds (eucalyptol, menthol, and thymol), and large-volume mouthwash ingestion will produce exposure in the reported toxic range of these ingredients. CONCLUSIONS: When ingested in large quantities, the phenolic compounds in mouthwash may contribute to a severe anion-gap metabolic acidosis and osmolar gap, multiorgan system failure, and death. These compounds, in addition to alcohol, may account for the adverse effects associated with massive mouthwash ingestion.

In-vivo glutaraldehyde fixation of the brain stem and spinal cord after inadvertent intrathecal injection.

A 64-year-old diabetic man underwent total maxillectomy with orbital exenteration because of recurrent carcinoma. In order to decrease pressure at the surgical site, 50 mL of cerebrospinal fluid were withdrawn. After the procedure was completed, 5% glutaraldehyde was inadvertently injected into the subarachnoid space instead of reinjection of the original cerebrospinal fluid. The patient suffered hypotension and coma culminating in death five days after the procedure. Postmortem examination revealed exquisite fixation of the outer cortical shell of the spinal cord and brain stem. The mishap occurred because an unlabeled vial was mistaken for the withdrawn cerebrospinal fluid. Graicunas' theory and formula on relationship complexities in organizations is exemplified by this occurrence. One may calculate the theoretical potential for 24,708 miscommunications during such a complex and lengthy surgical procedure. Proper operating room procedures must be developed and followed in order to prevent such tragedies.

-Severe self-poisoning with formol-. / Intoxication volontaire grave par le formol.

We report a case of voluntary poisoning with formalin in a 47-year-old man. The initial status included respiratory failure, metabolic acidosis and coagulopathy. Medical therapy consisted of mechanical ventilation, a single prolonged haemodialysis session, N-acetylcysteine, and folic acid administration. The corrosive damage to the gastrointestinal tract required an oesogastrectomy and three months later a colic transplant.

Improvements are needed in the existing packaging of medicated oils containing methyl salicylate.

In view of the toxic potential of medicated oils containing methyl salicylate, we have studied the existing packaging of 10 commonly used preparations from Hong Kong and Singapore and identified areas for improvement with respect to the prevention of poisonings. They were all packed in translucent bottles without child-resistant closures. The methyl salicylate content ranged from 15 to 67%. Many preparations also contained other potentially toxic ingredients in significant amounts, such as turpentine oil and camphor. The contents of the larger bottles could generally be emptied more easily because of the greater size of their openings. The product with the highest methyl salicylate content also had the biggest opening of all. The threat from ingestion of medicated oils containing methyl salicylate can probably be 'reduced' by: (i) using child-restraint closures; (ii) restricting the size of both the openings and the bottles; and (iii) reducing the methyl salicylate content.

Mercuric chloride poisoning due to ingestion of a stool fixative.

We present a case of ingestion of a commonly used stool fixative containing 675 mg of mercuric chloride per 15 mL vial. Early chelator therapy with dimercaprol and aggressive hydration were initiated and the patient remained asymptomatic. Safety packaging of this product is recommended.