Abstract
Background: Formic Acid is an industrial compound used in the coagulation of rubber latex in Kerala. Easy availability and accessibility of it makes it to be used as an agent of deliberate self harm. However, in literature, the complications of formic acid poisoning, both acute and chronic, is limited.
Objective: to identify and evaluate the clinical presentations of late complications of formic acid poisoning. A secondary objective was to determine the late complications affecting the upper gastrointestinal tract, kidneys and eye.
Methods: Patients who are admitted in the medical ward with history of ingestion of formic acid are interviewed during the acute phase and the clinical presentations and complications are recorded. Those who survived the acute event were followed up for a period of 6 months to look for complications, with the help of history and appropriate investigations.
Results: A tatal of 129 patients who were admitted could be followed up for 6 month period. The 24% ingested formic acid with ethanol and all of them were males. At presentation, GIT, Respiratory and Renal symptoms were predominant. Metabolic acidosis was present in 68.8% of patients, of which 33.3% were dialysed. On follow up, hematuria, albuminuria, elevated urea and creatinine were the major renal complications noted. Imapaired visual acuity, impred colour vision and abnormal optic fundii were the ophthalmological complications. On endoscopic evaluation changes in esophagus and stomach were present.
Conclusions: Late complications of Formic Acid ingestion are common in patients surviving the acute phase. Hence, those who survive the acute phase should be followed up to look for the development of complications. Patients with metabolic acidosis and renal impairement should be dialysed at the earliest to save lives.
Keywords: Formic Acid, Late complications.
References
- Census of India, Government of India, January 2011.
- Indian rubber statistics, Rubber Board, Ministry of Commerce and Industry, Government of India.
- Malizia E, Reale C, Peitolpaoli P, De Titis. Formic acid intoxications. Acta pharmacologica et toxicological. ( Suppl). 42. 342.
- Naik RB, Stephens WP, Wilson DJ, Walker A, Lee HA. Ingestion of Formic acid containing agents. Report of three fatal cases. Postgrad Med J 1980;56:451.
- Sujathan G, Jayapalan VK. Formic acid poisoning. J of Indian Acad of Forensic Medicine 1991:13;29-31.
- N Rajan, R Rahim and S Krishna kumar. Formic acid poisoning with suicidal intent. A report of 53 cases. Postgraduate Medical journal 1985;61:35-36.
- Sudhir M Naik, S Ravisankara, Mohan K Appaji, MK Goutham. Acute Accidental Formic acid poisoning: A common problem reported in rubber plantations in Sullia. A case report. 10.5005/jp journals-10001-1104.
- Dae Dallus MD, Asish Jacob Mathew, Saran Somarajan Pillai. Formic acid poisoning in a tertiary care centre in South India: A 2 year retrospective study. Emergency medicine. Vol 144, issue 2, February 2013;373-380.
- Chan TC, Williams SR, Clark R. Formic acid skin burns resulting in systemic toxicity. Annals of emergency medicine. 1995;26(3):383-386.
- Jon Sigurdsson, Arni Bjornsson, Sigurdur Gudmundsson. Formic acid burn- local and systemic effects. Report of a case burns . may 1983. 9 (5). 358-361.
- Hantson PE. Acute methanol intoxication: pathophysiology, prognosis and treatment. Bulletin et Memoires de L Academie royale de medicine de Belgique. 2006, 161(6): 425-434.
- Ellas JT, Salzman MM, Lewandowski MF, Murray TG. Formate induced alterations in retinal function in methanol intoxicated rats. Toxicol Appl Pharmacol. 140: 58-69
- Asish Jacob Mathe, Jacob George. Acute kidney injury in the tropics. Ann Saudi Med. 2011. Sept – Oct 31(5): 451-456.
- H Rachelle Wallage, James H Watterson. Formic acid and Methanol concentrations in death investigations. Journal of Analytical Toxicology. Vol 32. April 2008. 241-247.
- Nicholls P. the effect of Formate on cytochrome aa3 and on the electron transport in the intact respiratory chain. Biochem. Biophys Acta 1976;430:13-29.
- Martin Amat G, Mc Martrin KE, hayreh SS, Telphy TR. Methanol poisoning; Ocular toxicity produced by formate. Toxicol and appl pharmacology 1978;45:201-208.
Corresponding Author
Dr Arathi N
Lecturer, Department of Medicine, Government TD Medical College, Vandanam, Alappuzha 688005
Mobile 9446724558, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.109
