Toxicity of ingested formalin and its management

Formaldehyde is a physiological intermediary metabolite taking part in many biological process in the body. It is a constituent of many items of daily use, including foods. It is also used in medicine for treatment of some conditions. A 40% solution of formaldehyde in water is known as formalin. Formalin is irritating, corrosive and toxic and absorbed from all surfaces of the body. Ingestion is rare because of alarming odour and irritant effect but documented in accidental, homicidal or suicidal attempts. Ingestion can lead to immediate deleterious effects on almost all systems of the body including gastrointestinal tract, central nervous system, cardiovascular system and hepato-renal system, causing gastrointestinal hemorrhage, cardiovascular collapse, unconsciousness or convulsions, severe metabolic acidosis and acute respiratory distress syndrome. No specific antidote is available. Treatment of toxicity is supportive care of the various organ systems. Multidisciplinary approach is required for proper management.