Formaldehyde poisoning

Formaldehyde is a poisonous and at the same time very common chemical substance, namely a gas, the aqueous solution of which is known as formalin. In terms of toxicity, formaldehyde poisoning can be compared to arsenic or senile acid intoxication, so it often poses a danger not only to human health, but also to life. Initial signs of toxic effects are observed within the first twelve hours from the moment of poisoning. Treatment should be started as early as possible to prevent pathological changes in organs.

Epidemiology

Formaldehyde is a toxic agent that causes irritation of the respiratory and digestive tracts, organs of vision, skin and mucous membranes. The lethal amount of formaldehyde solution (formalin) is from 10 to 50 g. The lethal amount of pure formaldehyde is from 10 to 90 ml (depending on the age and initial health of the victim). The lethal presence of formaldehyde in the atmosphere is 578 mg per cubic meter.

Most often, formaldehyde poisoning is recorded in people who, due to their profession, regularly come into contact with the chemical (for example, when using or producing it). The maximum permissible concentration of the toxic substance in the air of a production site is limited to 0.5 mg per cubic meter.

Causes formaldehyde poisoning

Formaldehyde poisoning is possible if the toxic agent enters the body:

• through the respiratory tract (by inhalation);
• through the digestive tract (if swallowed);
• through the skin (when applied to the skin).

Intoxication begins immediately after direct contact with formaldehyde solutions or its vapors. A dangerous concentration of the toxic substance can almost always be determined by its characteristic odor.

What are the sources of poisoning:

• exhaust gas, smoke, soot;
• tobacco smoke;
• cosmetics, nail products;
• household chemical products;
• adhesives;
• medicines;
• low-quality furniture made from plywood, chipboard, MDF;
• carpeting, carpeting;
• chemicals for plant treatment.

Risk factors

• Professional activity related to the production of wood-based materials, fibreboards and products made from them.
• Smoking abuse, substance abuse.
• Poor ventilation of premises, lack of airing.
• Self-medication, long-term use of medications without a doctor's prescription.
• Improper storage of household chemicals and medicines at home.

Pathogenesis

Formaldehyde is found in a wide variety of products, including household chemicals, cosmetics, and even medications. Tiny amounts of this substance are considered harmless, but highly concentrated solutions cause irreparable harm to health and can even be life-threatening.

Formaldehyde poisoning is most often caused by formalin – a 40% aqueous formaldehyde solution (it also contains a small amount of industrial alcohol as an auxiliary component). Formaldehyde is colorless, but its aroma is distinct, sharp and extremely unpleasant. It is the smell that allows one to accurately “guess” the chemical. [ 1 ]

Formaldehyde is used to produce urea-formaldehyde resins, which are then used to make chipboard, plywood, MDF, laminate, etc. In addition, formaldehyde solution is included in some disinfectants, embalming preparations, cosmetics, household chemicals and medicines.

Formaldehyde is toxic, it has an irritating and cauterizing property. When entering the body, the toxic substance undergoes oxidation and is transformed into formic acid. Such a transformation overloads the kidneys, so against the background of poisoning, renal failure often develops. The removal of the toxic agent from the body is extremely slow. [ 2 ]

In addition to the kidneys, formaldehyde has adverse effects on the brain and nervous system, as well as the digestive tract.

Another danger is that formaldehyde penetrates all tissues of the body extremely quickly. For example, only when it enters the esophagus, the toxic substance is found in the bone marrow within twelve hours. This is one of the factors that explains the extreme need for emergency medical care.

Symptoms formaldehyde poisoning

The severity of formaldehyde poisoning symptoms depends largely on the amount of toxic substance in the body or the amount of gas in the inhaled air. For a healthy adult, a lethal amount of formaldehyde is considered to be between 50 and 90 ml. [ 3 ]

The first signs of formaldehyde poisoning in adults are:

• increased salivation, lacrimation;
• discomfort in the throat, shortness of breath, dry “barking” cough, sometimes laryngeal edema with inability to inhale;
• increasing nausea (to the point of vomiting), spasmodic pain in the abdominal cavity;
• dilated pupils;
• esophageal pain;
• impaired motor coordination, unsteady gait, tremors of the limbs;
• tachycardia, hypotension;
• pain, skin hyperemia, formation of blisters when a chemical agent comes into contact with the skin;
• clouding of consciousness, even to the point of coma.

Formaldehyde vapor poisoning is accompanied by difficulty breathing and a hacking cough. Pulmonary edema may develop - a condition that is life-threatening for a person, which is characterized by severe weakness, increased heart rate, hyperhidrosis, paroxysmal coughing, which intensifies in a lying position. With prolonged exposure of formaldehyde vapors to the respiratory system, signs of damage to the central nervous system are noted: the victim experiences dizziness and loss of coordination, he is bothered by a feeling of anxiety and fear. Convulsions may occur. [ 4 ]

Many consumers are concerned about the question: is it possible to be poisoned by formaldehyde from furniture, and how does it manifest itself? Indeed, if the furniture is made of chipboard, and there is a lot of such furniture in the room, then under certain conditions poisoning can occur. It has been proven that formaldehyde is released in small quantities by furniture and some floor coverings for three to five years. Here are the signs that accompany such intoxication:

• frequent allergies, regular asthma attacks, cough that is almost impossible to cure;
• insomnia or drowsiness, unexplained weight loss, irritability;
• regular headaches, visual impairment;
• chronic fatigue syndrome;
• unexplained increase in sweating, periodic unexplained changes in body temperature.

Chronic formaldehyde poisoning can often be found in workers who regularly come into contact with formaldehyde in one form or another. With such intoxication, dermatitis (including on the face), onychodystrophy are observed. Some people develop allergic processes, eczema. Over time, with constant contact with the toxic agent, sensitivity to formaldehyde increases.

Stages

There are the following stages of formaldehyde exposure to the body:

• If the toxic effect does not exceed 40 mcg/kilogram, we speak of a low level of poisoning, in which pathological symptoms are practically not detected.
• In case of intoxication in the range from 40 to 100 mcg/kilogram, breathing problems, coughing, wheezing appear. Signs of an allergic reaction are possible.
• At high levels of intoxication, exceeding 100 mcg/kilogram, irritation of the mucous membranes of the eyes and nasopharynx is observed, and serious respiratory disorders are also recorded.

In addition, it is important to distinguish between short-term and long-term exposure to formaldehyde. Short-term exposure is when the victim does not regularly work with adhesives, building materials, finishing products, paints, etc. Long-term exposure occurs, for example, after purchasing new furniture, after major finishing of the premises, etc. Some types of furniture and floor coverings are capable of releasing toxic substances for a long time, which is especially dangerous in closed, sealed rooms. [ 5 ]

Complications and consequences

High concentrations of formaldehyde can significantly increase the risk of developing cancerous tumors. For example, sinus cancer is often diagnosed in workers employed in industries that regularly involve contact with formalin. Such complications are rare in everyday life.

With prolonged exposure to medium concentrations of the toxic substance (doses that do not irritate mucous tissues), the development of respiratory complications and allergic processes is not excluded. The child's body is more susceptible to the harmful effects of the chemical compound.

Severe intoxication can lead to the development of complications that threaten the life of the victim:

• In case of ulceration of the internal walls of the digestive tract (in particular, the stomach and duodenum), damage to blood vessels and bleeding are possible. The complication is manifested by bloody-dark vomiting, liquid dark stool, severe weakness and pale skin. [ 6 ]
• In toxic liver damage, acute liver dysfunction and hepatitis develop. The pathology manifests itself in yellowing of the skin and mucous membranes, hypochondrium pain on the right side, and impaired consciousness.
• In case of toxic kidney damage, edema and anuria are detected. [ 7 ]
• When inhaling formaldehyde vapors, pulmonary edema, swelling of the laryngeal mucosa and, as a consequence, asphyxia occur.

Diagnostics formaldehyde poisoning

One of the main activities associated with the diagnosis of formaldehyde poisoning is the collection of an epidemiological anamnesis. Both the victim and his immediate environment are carefully questioned. Important questions may include:

• professional characteristics;
• the presence of harmful addictions;
• living conditions and features.

It is equally important to find out what preceded the poisoning and how the chemical agent could have entered the human body.

Subsequent diagnostics are based on information obtained during clinical laboratory or pathomorphological diagnostic procedures. General clinical urine and blood tests are performed, as well as qualitative and quantitative studies of toxic agents that have entered the patient's body. In addition, a biochemical blood test is performed, the results of which help to detect impaired functions typical of chemical poisoning of the body. [ 8 ]

Instrumental diagnostics consists of assessing the functionality of vital organs and systems. The following is mandatory:

• electrocardiography;
• measurement of blood pressure and pulse rate.

If necessary, gastroduodenoscopy, encephalography, ultrasound of the heart and internal organs are prescribed.

Pathomorphological diagnostics is based on information obtained during autopsies of patients who died as a result of formaldehyde poisoning.

Differential diagnosis

Differential diagnostics are carried out with other intoxications - for example, with poisoning by acidic and alkaline solutions, poisonous plants and liquids, etc.

Treatment formaldehyde poisoning

If a person has been poisoned by formaldehyde vapors, he or she must be taken outside immediately and provided with fresh air. It is imperative to soak a cotton pad or napkin in ammonia and bring it to the victim's nose. The ammonia solution will react with formaldehyde, resulting in the transformation of the toxic substance into a non-toxic compound - urotropine.

If formalin has been taken internally, it is not allowed to wash out the stomach until the ambulance arrives. The victim should drink as much clean water as possible. An antidote in the form of ammonia-anise drops can be added to the drink.

In case of toxic damage to the visual organs, they are washed with warm clean water, after which several drops of novocaine (0.5% solution) are dripped into each eye.

If the skin is damaged, it is washed well, dried and moistened with a 5-10% solution of ammonia (ammonia). [ 9 ]

Medicines that a doctor may prescribe

Severe formaldehyde poisoning can be accompanied by severe, pronounced symptoms and is often complicated, so it is very important to start treating the intoxication quickly. At the first suspicion of poisoning, you should immediately call an ambulance.

If the victim has respiratory problems, then respiratory analeptics are prescribed - drugs that stimulate the respiratory and vasomotor centers:

• Lobeline is administered as intramuscular or intravenous (slow) injections of 0.3-1 ml of a 1% solution. In childhood, the dosage is 0.1-0.3 ml. Side effects may occur with an overdose of the drug and include stimulation of the vomiting center and respiratory depression.
• Cytiton is administered both intramuscularly and intravenously at 0.5-1 ml. For children - from 0.1 to 0.5 ml, depending on age. Among the most likely side effects when using the drug are bradycardia, nausea, vomiting. Cytiton is not prescribed for pulmonary edema and internal bleeding.

Additionally, measures are taken to prevent laryngeal edema. [ 10 ]

If it is necessary to alleviate the state of psychomotor agitation, tranquilizers are used:

• Diazepam (Sibazon, Relanium) is taken orally at 2.5-10 mg 3-4 times a day. Possible side effects: drowsiness, apathy, dyspepsia, increased salivation. The drug is discontinued gradually.
• Afobazole - taken orally, based on an average daily dosage of 30 mg. Duration of treatment - up to one month. Possible development of an allergic reaction, nausea, diarrhea. The drug is not prescribed to children under 18 years of age.
• Phenazepam - taken orally at 0.25-0.5 mg three times a day (the dosage may be increased at the discretion of the doctor, provided that the patient is in a hospital under medical supervision). Possible side effects: muscle weakness, drowsiness, dizziness. Phenazepam is not prescribed for severe renal or hepatic dysfunction.

If the patient is experiencing severe pain, narcotic analgesics may be prescribed, such as Promedol or Omnopon.

When formalin is used internally in hospital settings, the stomach is washed using a special probe with a wide lumen. The antidote for washing is 2% ammonium chloride or carbonate, or ammonium salt of acetic acid. [ 11 ]

Prevention

Since formaldehyde poisoning most often occurs at enterprises associated with the production or use of chemicals, preventive measures should be carried out there first of all. Although, in everyday life, prevention is no less obligatory. Here is what it consists of:

• When working with formaldehyde, all safety regulations must be observed.
• The use of personal protective equipment cannot be ignored.
• In everyday life, you should avoid products containing formaldehyde.
• It is necessary to give up such a harmful addiction as smoking (or at least avoid smoking indoors).
• It is important to regularly ventilate the apartment and especially the sleeping rooms (formaldehyde can be contained in furniture, carpets, etc.).
• At the first suspicious signs, you should seek medical help.

Forecast

The quality of the prognosis depends not only on the dose, but also on the timeliness of medical care. Early treatment and qualified emergency care provide the maximum chance to prevent serious health problems and avoid death.

Formaldehyde poisoning is a very dangerous condition. The chemical agent damages the respiratory system, negatively affects the central nervous system and all key body systems. At the slightest suspicion of intoxication, you should contact specialists as soon as possible: self-treatment of this type of poisoning is strictly prohibited.