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Acute formic acid poisoning: a case series analysis with current management protocols and review of literature.

Background: Formic acid in concentrated form being pungent and easily available can be consumed for suicidal purposes and the dilute form being colourless and odourless is consumed accidentally. Accidental ingestion is rare and deliberate self-harm is very painful and violent which has been a rare modality of committing suicide but for these rubber plantation areas where it is easily available.

Materials and methods: This is a retrospective case series analysis study of 14 patients with acute formic acid poisoning. There were 14 patients, with 3 females and 11 males. The average age was 35.5 years, with the average in males being 34.9 and 37.6 in females. 30 ml was considered as cutoff range, as diluted/ undiluted FA below 30 ml were managed in our institution and 30ml+ were referred to higher toxicology specialty care.

Results: Act of deliberate self-harm was seen in 11 cases (78.5%) and accidental ingestion in 3 cases (21.5%). All had orofacial burns, 4 had mild hematemesis and 3 severe hematemesis with impending renal complications. All the stabilized and referred cases were no further evaluated for follow up. Facial burns and contracture needing cosmetic correction was seen in 3 cases, while corneal and lid scarring seen in 2 cases while a case of esophageal stricture with lower GIT and renal complications were seen in one case.

Conclusion: Formic acid poisoning is uncommon and limited literature review are available with fewer protocols laid. Immediate management of this corrosive poisoning with supportive measures reduces the mortality drastically. Serial upper gastrointestinal imaging diagnose the strictures earlier and cosmetic reconstruction helps in facial scarring and contractures.

Author(s): Gautham MK Ravishankara S Sudhir M Naik Sathya P Mohan Appaji Shankarnarayan Bhat Bhat CR Chidananda KV