Formaldehyde poisoning

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

Epidemiology

Formaldehyde is a toxic agent that causes irritation from the respiratory and digestive tract, 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 state of 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 persons who, due to their profession, regularly come into contact with the chemical (for example, during its use or production). The maximum permissible concentration of a toxic substance in the air of a production site is limited to 0.5 mg per cubic meter.

Causes

Formaldehyde poisoning is possible if a 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. The dangerous concentration of a toxic substance can almost always be determined by its characteristic odor. [1]

What are the sources of poisoning:

• exhaust gas, smoke, soot;
• tobacco smoke;
• cosmetics, nail products;
• household chemical products;
• adhesives;
• medicines;
• low-quality furniture made on the basis of plywood, chipboard, MDF;
• carpets, carpet;
• plant treatment chemicals.

Risk factors

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

Pathogenesis

Formaldehyde is found in a wide variety of foods, such as household chemicals, cosmetics, and even medicines. Minor amounts of this substance are considered harmless, but highly concentrated solutions cause irreparable harm to health and can even pose a threat to life.

Most often, formalin becomes the culprit of formaldehyde poisoning - we are talking about a 40% formaldehyde aqueous solution (as an auxiliary component, it also contains a small amount of technical alcohol). Formalin has no color, but its aroma is distinct, pungent and extremely unpleasant. It is the smell that makes it possible to unmistakably "guess" the chemical. [2]

Formaldehyde is used for the production of urea-formaldehyde resins, which are later used for the manufacture of chipboard, plywood, MDF, laminate, etc. In addition, formaldehyde solution is included in some disinfectants, embalming agents, cosmetics, household chemicals and medicines.

Formaldehyde is toxic, irritating and cauterizing. When a poisonous substance enters the body, it undergoes oxidation and transforms into formic acid. Such a transformation overloads the kidneys, therefore, against the background of poisoning, renal failure often develops. Removal of the toxic agent from the body is extremely slow. [3]

In addition to the kidneys, formaldehyde adversely affects the brain and nervous system, as well as the digestive tract.

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

Symptoms

How pronounced the symptoms of formaldehyde poisoning become depends largely on the volume of the toxic substance in the body, or on the gas content in the inhaled air. An amount of formaldehyde from 50 to 90 ml is considered lethal for a healthy adult. [4]

The first signs of formaldehyde poisoning in adults are as follows:

• increased salivation, lacrimation;
• discomfort in the throat, shortness of breath, dry "barking" cough, sometimes - laryngeal edema with inability to inhale;
• increasing nausea (before vomiting), spastic pain in the abdominal cavity;
• dilated pupils;
• esophageal pain;
• impaired motor coordination, unsteady gait, limb tremor;
• tachycardia, hypotension;
• soreness, skin hyperemia, the formation of bubbles when a chemical agent enters the skin;
• clouding of consciousness, up to coma.

Poisoning with formaldehyde vapors is accompanied by shortness of breath, harsh cough. Pulmonary edema may develop - a condition that threatens a person, which is characterized by severe weakness, increased heart rate, hyperhidrosis, paroxysmal cough, aggravated in the supine position. With prolonged intake of formaldehyde vapors into the respiratory system, signs of damage to the central nervous system are noted: the victim has dizziness and lack of coordination, he is worried about a feeling of anxiety and fear. Convulsions are possible. [5]

Many consumers are concerned about the question: is formaldehyde poisoning from furniture possible, 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. Small amounts of formaldehyde have been shown to be released from furniture and some floor coverings over a period of three to five years. Here are the signs accompanied by such intoxication:

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

Chronic formaldehyde poisoning is common among workers who regularly come into contact with some form of formaldehyde. With such intoxication, dermatitis (including on the face), onychodystrophy are noted. Some people develop allergic processes, eczema. Over time, with constant contact with a toxic agent, the sensitivity to formaldehyde increases.

Stages

There are such stages of the effect of formaldehyde on the body:

• With a toxic effect not exceeding 40 μg / kg, they speak of a low level of poisoning, in which pathological symptoms are practically not detected.
• With intoxication in the range from 40 to 100 mcg / kg, breathing disorders, coughing, wheezing appear. Signs of an allergic reaction are possible.
• With a high level of intoxication, exceeding 100 μg / kg, irritation of the mucous membrane of the eyes and nasopharynx is observed, as well as serious respiratory disorders.

In addition, it is important to distinguish between short and long-term effects of formaldehyde on the body. They say about a short exposure if the victim does not regularly work with glue, building materials, finishing products, paints, etc. Long-term exposure occurs, for example, after purchasing new furniture, after major finishing the premises, etc. Some types of furniture and floor coverings are capable of to release toxic substances for a long time, which is especially dangerous in closed sealed rooms. [6]

Complications and consequences

High concentrations of formaldehyde can significantly increase the risk of developing cancer. For example, nasal sinus cancer is often diagnosed in workers in jobs that have regular exposure to formalin. In everyday life, such complications are rare.[7]

With prolonged exposure to medium concentrations of a 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 a chemical compound.

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

• With ulceration of the inner walls of the digestive tract (in particular, the stomach and duodenum 12), vascular damage and bleeding are possible. The complication is manifested by bloody-dark vomiting, loose, dark-colored stools, severe weakness and pale skin. [8]
• With toxic damage to the liver, acute failure of its function, hepatitis, develops. Pathology is manifested by yellowing of the skin and mucous membranes, hypochondrium pain on the right side, impaired consciousness.
• With toxic damage to the kidneys, edema, anuria are found. [9]
• Inhalation of formaldehyde vapors causes pulmonary edema, swelling of the laryngeal mucosa and, as a result, asphyxia.

Diagnostics

One of the main activities associated with the diagnosis of formaldehyde poisoning is the collection of an epidemiological history. Both the victim himself and his immediate circle are carefully questioned. Important questions might include:

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

It is equally important to find out what preceded the poisoning, how the chemical agent could enter the human body.

Subsequent diagnostics is based on information obtained during clinical laboratory or pathomorphological diagnostic procedures. General clinical analyzes of urine and blood are performed, as well as qualitative and quantitative studies of toxic agents that have entered the patient's body. As a supplement, a biochemical blood test is carried out, the results of which help to detect impaired functions typical for chemical poisoning of the body. [10]

Instrumental diagnostics consists in assessing the functionality of vital organs and systems. It is mandatory to appoint:

• electrocardiography;
• measurement of blood pressure indicators, pulse rate.

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

Pathological diagnosis is based on information obtained during the autopsy of patients who died as a result of formaldehyde poisoning.

Differential diagnosis

Differential diagnosis is carried out with other intoxications - for example, with poisoning with acid and alkaline solutions, poisonous plants and liquids, etc.

Treatment

If a person has been poisoned with formaldehyde vapors, then he must be urgently taken out into the street, to ensure the flow of clean air. It is imperative to moisten 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 is taken internally, then it is not allowed to wash the stomach before the arrival of the ambulance. The victim should drink as much clean water as possible. The antidote can be added to the drink in the form of ammonia-anise drops.

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

If the skin is damaged, then they are washed well, dried and moistened with 5-10% ammonia solution (ammonia). [11]

Medicines that a doctor may prescribe

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

If breathing disorders are recorded in the victim, then respiratory analeptics are prescribed - drugs that stimulate the respiratory and vasomotor center:

• Lobelin - 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 can appear in case of an overdose of the drug and consist in the excitation of the vomiting center, respiratory depression.
• Cititon - injected both intramuscularly and intravenously, 0.5-1 ml. Children - from 0.1 to 0.5 ml, depending on age. Among the most likely side symptoms when using the drug are bradycardia, nausea, vomiting. With pulmonary edema and internal bleeding, Cytiton is not prescribed.

Additionally, measures are taken to prevent laryngeal edema. [12]

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 withdrawn gradually.
• Afobazol - taken orally, based on an average daily dosage of 30 mg. The duration of treatment is up to one month. Possible development of an allergic reaction, nausea, diarrhea. The drug is not prescribed for children under 18 years of age.
• Phenazepam - taken orally at 0.25-0.5 mg three times a day (the dosage can be increased at the discretion of the doctor, provided that the patient is in a stationary environment under medical supervision). Possible side effects: muscle weakness, drowsiness, dizziness. In case of severe impairment of renal or hepatic function, Phenazepam is not prescribed.

If the patient is worried about severe pain, it is possible to prescribe narcotic analgesics, for example, Promedol or Omnopon.

For internal use of formalin in a hospital setting, the stomach is washed using a special probe with a wide lumen. Antidote for washing - 2% ammonium chloride or carbonate, or ammonium salt of acetic acid. [13]

Prevention

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

• Work with formaldehyde should comply with all safety rules.
• The use of personal protective equipment cannot be ignored.
• In everyday life, products with formaldehyde in the composition should be avoided.
• It is necessary to give up such harmful addictions as smoking (or, at least, avoid smoking indoors).
• It is important to regularly ventilate the apartment and especially the sleeping rooms (formaldehyde can be found in furniture, carpets, etc.).
• At the first suspicious signs, you need to seek medical help.

Forecast

The quality of the forecast depends not only on the exposure dose, but also on the timeliness of medical care. An earlier visit to a doctor, qualified emergency care gives the maximum chances 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 need to contact a specialist as soon as possible: self-treatment of this kind of poisoning is strictly prohibited.