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Home / Equine Research Bank / Equine Vet J / Survival of formalin intoxication in a 13-year-old Thoroughb...
Equine veterinary journal2023; doi: 10.1111/evj.13982

Survival of formalin intoxication in a 13-year-old Thoroughbred gelding.

Abstract: Formalin intoxication via the gastrointestinal route has not been previously reported in the horse. Whereas ingestion of formalin in humans, although rare, is well documented. Majority of human cases are either accidental, suicidal or homicidal and often lead to fatality, with a reported lethal formaldehyde dose equating to 0.12 - 0.16 g/kg bwt. Objective: To describe a single case report of the clinical management of an adult horse referred to a veterinary teaching hospital following accidental administration of 10% formalin via nasogastric tube. Methods: A 13-year-old Thoroughbred gelding originally presented to the referring veterinarian for colic where 1.8 L of 10% formalin was accidentally administered instead of mineral oil via nasogastric intubation, a potentially lethal dose of formaldehyde (0.12 g/kg bwt). Approximately 20-hours following 10% formalin administration the horse was admitted to the referral hospital with moderate tachycardia, occasional ectopic beats, tacky and hyperaemic mucous membranes, delayed capillary refill time, reduced borborygmi, and pronounced digital pulses. Diagnostic investigations included laboratory blood analysis, urinalysis, electrocardiogram, abdominal ultrasound, palpation per rectum and gastroscopy. Results: Patient assessment found evidence of toxicity to the gastrointestinal tract, hypovolaemia and risk for laminitis. Intensive care included fluid and electrolyte therapy, anti-inflammatories and analgesia, continuous digital cryotherapy, gastro-protectants and other methods of gastrointestinal support. The horse was discharged from hospital on day 14 with no long-term complications and the client-veterinarian relationship was preserved. Conclusions: In human cases of ingestion, gastrointestinal injury is typically accompanied by severe metabolic acidosis and multiple organ dysfunction syndrome due to toxicity of other body systems that can contribute to non-survival. Formaldehyde toxicity in the present case predominantly affected the gastrointestinal tract, most likely a direct result of the route of administration. Aside from gastrointestinal injury, primary toxicity of other body systems was not confirmed. To prevent this medical error recurring, the referring veterinary clinic revised their labelling and storage of 10% formalin. Conclusions: This is the first report of systemic formalin intoxication in the horse. Following a high dose of 10% formalin (0.12 g/kg bwt formaldehyde) enterally, the horse survived having received intensive supportive care based on human guidelines for ingested formalin.
© 2023 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2023-08-16 PubMed ID: 37587652DOI: 10.1111/evj.13982Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research examines a unique case where a 13-year-old horse survived formalin intoxication, caused by an accidental administration of the substance via the horse’s gastrointestinal tract. The study emphasizes on the effects of the intoxication, the medical interventions used, and the importance of accurate labelling and storage of hazardous substances in veterinary clinics.

Objective and Methodology

  • This study primarily aimed to shed light on an unprecedented event of a horse surviving formalin intoxication. Formalin intoxication is relatively common in humans due to accidents, suicidal attempts, etc., and it often leads to fatalities with reported lethal doses equaling 0.12 – 0.16 g/kg bwt.
  • However, in this case, the accidental administration was not fatal. A 13-year-old Thoroughbred gelding was originally given 1.8 L of 10% formalin via nasogastric tube instead of mineral oil, acts as a potentially lethal dose of formaldehyde (0.12 g/kg bwt).
  • Several diagnostic tests were performed to assess the horse’s physical state and the impact of the formalin ingestion, including blood analysis, urinalysis, electrocardiogram, abdominal ultrasound, palpation, and gastroscopy.

Results and Interventions

  • The horse showed signs of gastrointestinal toxicity, hypovolaemia, and laminitis risk. It was given intensive care, which included fluid and electrolyte therapy, anti-inflammatories and analgesics, constant cryotherapy, gastro-protectants, and other gastrointestinal support measures.
  • Despite the severity of the accidental intake, the horse was discharged on the 14th day without any chronic complications.
  • Mainly, the toxicity impacted the gastrointestinal tract, with no substantial evidence showing that other body systems were affected. This seems to be because the route of administration was the gastrointestinal tract.

Conclusion and Lessons Learned

  • Based on this case, the referring veterinary clinic took steps to revise their method of labeling and storage to avert such medical mishaps in the future.
  • Although human ingestion often leads to severe metabolic acidosis and organ dysfunction, the noted horse showed mainly gastrointestinal disruptions. It was able to survive the intoxication, possibly thanks to the intensive support it received which was based on human guidelines for formalin ingestion.
  • This unprecedented case of systemic formalin intoxication in a horse serves to expand our understanding of the effects of formalin across species and highlights the importance of caution in veterinary practice.

Cite This Article

APA
Lovett A, Vokes J, Loghides N, Johnstone L, Sykes B. (2023). Survival of formalin intoxication in a 13-year-old Thoroughbred gelding. Equine Vet J. https://doi.org/10.1111/evj.13982

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Lovett, Amy
  • Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand.
Vokes, Jessica
  • Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand.
Loghides, Natasha
  • Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand.
Johnstone, Laura
  • Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand.
Sykes, Benjamin
  • Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand.

References

This article includes 66 references
  1. Schumacher J, Yarbrough T, Pascoe J, Woods P, Meagher D, Honnas C. Transendoscopic chemical ablation of progressive ethmoidal hematomas in standing horses.. Vet Surg 1998;27:175-181.
  2. Marriott M, Dart A, Hodgson D. Treatment of progressive ethmoidal haematoma using intralesional injections of formalin in three horses.. Aust Vet J 1999;77:371-373.
  3. Barakzai S. Equine respiratory tract-intra-sinus progressive ethmoidal haematoma.. UK Vet Livestock 2013;18:43-45.
  4. Siwińska N, Jankowiak B, Marchewczyk K, Zmiertka M, Przewozny M. Treatment of progressive ethmoid hematoma in horse using local injection of 10% formalin solution-a case report.. Życie Weterynaryjne 2017;92:200-203.
  5. Pandey C, Agarwal A, Baronia A, Singh N. Toxicity of ingested formalin and its management.. Hum Exp Toxicol 2000;19:360-366.
  6. Eells JT, McMartin KE, Black K, Virayotha V, Tisdell RH, Tephly TR. Formaldehyde poisoning: rapid metabolism to formic acid.. JAMA 1981;246:1237-1238.
  7. Afrin M, Amin T, Karim M, Islam MR. Effects of formaldehyde intoxication on liver of Swiss albino mice.. IOSR J Agric Vet Sci 2016;9:76-81.
  8. Strubelt O, Brasch H, Pentz R, Younes M. Experimental studies on the acute cardiovascular toxicity of formalin and its antidotal treatment.. J Toxicol Clin Toxicol 1990;28:221-233.
  9. Afifi NM, Hanon AF. Histological and immunohistochemical study on the possible cardioprotective role of acetylcysteine in oral formalin myocardial toxicity in adult albino rats.. Egypt J Histol 2011;34:859-869.
  10. Khatun A, Rana MM, Khan MRI, Wahed II, Habib A, Sathi ZS. Molecular mechanism of formalin-induced toxicity and its management.. Am J Life Sci 2015;3:85-92.
  11. Frees KE, Gaughan EM, Lillich JD, Cox J, Gorondy D, Nietfeld JC. Severe complication after administration of formalin for treatment of progressive ethmoidal hematoma in a horse.. J Am Vet Med Assoc 2001;219(7):950-952.
  12. Maischberger E, Jackson MA, Kühn K, Grest P, de Brot S, Wehrli EM. Ethmoid adenocarcinoma: severe neurological complications after combined laser ablation and intralesional formalin injection.. Equine Vet Educ 2014;26:563-567.
  13. Vos H, Luinstra M, Pauw R. Survival of a formalin intoxication: a case report.. Netherlands J Crit Care 2017;25:133-136.
  14. Sidhu K, Sidhu J. An alleged poisoning with methanol and formaldehyde.. Vet Hum Toxicol 1999;41:237-242.
  15. Eichler H, Hruby K, Katschnig M, Leinzinger P. Accidental fatal formaldehyde poisoning.. Wien Klin Wochenschr 1983;95:243-245.
  16. Sahu SS, Naveen A, Mohanty MK, Kundu A. Accidental formalin poisoning in a child with acute fatal manifestations: a rare case report.. J Fam Med Prim Care 2022;11:3293-3297.
  17. Zhang L, Li Y, Wang L, Zhang S, Zhang G, Zuo M. A fatal case of accidental oral formaldehyde poisoning and its pathomorphological characteristics.. Int J Leg Med 2022;136:1-5.
  18. Walpole SC, Prieto-Merino D, Edwards P, Cleland J, Stevens G, Roberts I. The weight of nations: an estimation of adult human biomass.. BMC Public Health 2012;12:1-6.
  19. Bithell S, Habershon-Butcher JL, Bowen IM, Hallowell GD. Repeatability and reproducibility of transabdominal ultrasonographic intestinal wall thickness measurements in Thoroughbred horses.. Vet Radiol Ultrasound 2010;51:647-651.
  20. Gratwick Z. An updated review: laboratory investigation of equine renal disease.. Equine Vet Educ 2021;33:546-555.
  21. Kim M-H, Kim H. The roles of glutamine in the intestine and its implication in intestinal diseases.. Int J Mol Sci 2017;18:1051.
  22. Reef VB. Equine diagnostic ultrasound.. WB Saunders Company, Philadelphia. 1998.
  23. Hendrickson EH, Malone ED, Sage AM. Identification of normal parameters for ultrasonographic examination of the equine large colon and cecum.. Can Vet J 2007;48:289-291.
  24. Moreno C, Delph K, Beard W. Intravenous formalin for treatment of haemorrhage in horses.. Equine Vet Educ 2021;33:e460-e465.
  25. Baek S-H, Kim K-H, Park J-S. A case of intoxication of ingested formalin.. J Korean Soc Clin Toxicol 2009;7:38-40.
  26. Yanagawa Y, Kaneko N, Hatanaka K, Sakamoto T, Okada Y, Yoshimitu S-I. A case of attempted suicide from the ingestion of formalin.. Clin Toxicol 2007;45:72-76.
  27. Köppel C, Baudisch H, Schneider V, Ibe K. Suicidal ingestion of formalin with fatal complications.. Intensive Care Med 1990;16:212-214.
  28. Hawley CK, Harsch HH. Gastric outlet obstruction as a late complication of formaldehyde ingestion: a case report.. Am J Gastroenterol 1999;94:2289-2291.
  29. Boeniger MF. Formate in urine as a biological indicator of formaldehyde exposure: a review.. Am Ind Hyg Assoc J 1987;48:900-908.
  30. Dalus D, Mathew AJ, Pillai SS. Formic acid poisoning in a tertiary care center in South India: a 2-year retrospective analysis of clinical profile and predictors of mortality.. J Emerg Med 2013;44:373-380.
  31. Brunner R, Kurz A, Adelsmayr G, Holzinger U. Basal glucosuria is ubiquitous in critically ill patients.. Nephrol Ther 2015;20:293-296.
  32. Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review.. Kidney Int 2008;73:538-546.
  33. Lopes JA, Fernandes P, Jorge S, Gonçalves S, Alvarez A, Costa e Silva Z. Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications.. Crit Care 2008;12:1-8.
  34. Thoen ME, Kerl ME. Characterization of acute kidney injury in hospitalized dogs and evaluation of a veterinary acute kidney injury staging system.. J Vet Emerg Crit Care 2011;21:648-657.
  35. Savage VL, Marr CM, Bailey M, Smith S. Prevalence of acute kidney injury in a population of hospitalized horses.. J Vet Intern Med 2019;33:2294-2301.
  36. Divers TJ. Acute kidney injury and renal failure in horses.. Vet Clin Equine Pract 2022;38:13-24.
  37. Siwinska N, Zak A, Slowikowska M, Niedzwiedz A, Paslawska U. Serum symmetric dimethylarginine concentration in healthy horses and horses with acute kidney injury.. BMC Vet Res 2020;16:1-6.
  38. Brashier MK, Geor RJ, Ames TR, O'Leary TP. Effect of intravenous calcium administration on gentamicin-induced nephrotoxicosis in ponies.. Am J Vet Res 1998;59:1055-1062.
  39. Siwinska N, Zak A, Paslawska U. Detecting acute kidney injury in horses by measuring the concentration of symmetric dimethylarginine in serum.. Acta Vet Scand 2021;63:1-10.
  40. Pumphrey C, Beck E. Raised blood urea concentration indicates considerable blood loss in acute upper gastrointestinal haemorrhage.. Br Med J 1980;280:527-528.
  41. Prause LC, Grauer GF. Association of gastrointestinal hemorrhage with increased blood urea nitrogen and BUN/creatinine ratio in dogs: a literature review and retrospective study.. Vet Clin Pathol 1998;27:107-111.
  42. Takeshita D, Nakajima-Takenaka C, Shimizu J, Hattori H, Nakashima T, Kikuta A. Effects of formaldehyde on cardiovascular system in in situ rat hearts.. Basic Clin Pharmacol Toxicol 2009;105:271-280.
  43. Hovda KE, McMartin K, Jacobsen D. Methanol and formaldehyde poisoning.. In: Brent J, Megarbane B, Palmer R, Hatten B, Burkhart K, editors. Critical care toxicology. 2nd ed. New York: Springer Publishing; 2017.
  44. Ferrandière M, Dequin P, Legras A. Severe self-poisoning with formol.. Annales francaises d'anesthesie et de reanimation 1998;17:254-256.
  45. Cohen ND, Carter GK, Mealey RH, Taylor TS. Medical management of right dorsal colitis in 5 horses: a retrospective study (1987-1993).. J Vet Intern Med 1995;9:272-276.
  46. Davis J. Nonsteroidal anti-inflammatory drug associated right dorsal colitis in the horse.. Equine Vet Educ 2017;29:104-113.
  47. Sykes B, Hewetson M, Hepburn R, Luthersson N, Tamzali Y. European College of Equine Internal Medicine Consensus Statement-equine gastric ulcer syndrome in adult horses.. J Vet Intern Med 2015;29:1288-1299.
  48. Smith BP. Large animal internal medicine.. E-Book Elsevier Health Sciences, Missouri, 2014.
  49. Liu N, Ma X, Luo X, Zhang Y, He Y, Dai Z. l-glutamine attenuates apoptosis in porcine enterocytes by regulating glutathione-related redox homeostasis.. J Nutr 2018;148:526-534.
  50. Yi D, Hou Y, Wang L, Ouyang W, Long M, Zhao D. L-glutamine enhances enterocyte growth via activation of the mTOR signaling pathway independently of AMPK.. Amino Acids 2015;47:65-78.
  51. Dunkel B, McKenzie HC 3rd. Severe hypertriglyceridaemia in clinically ill horses: diagnosis, treatment and outcome.. Equine Vet J 2003;35:590-595.
  52. Parsons D. The large intestine: its role in mammalian nutrition and homeostasis. By OM Wrong, CJ Edmonds and VS Chadwick. Pp. 1-2. (MTP Press Ltd, Lancaster).. Q J Exp Physiol Transl Integr 1982;67:361-362.
  53. Meyer H. Influence of feed intake and composition, feed and water restriction, and exercise on gastrointestinal fill in horses.. Equine Practice 1996;18:20-23.
  54. Pagan J, Hintz H. Equine energetics. I. Relationship between body weight and energy requirements in horses.. J Anim Sci 1986;63:815-821.
  55. De Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review.. BMJ Qual Saf 2008;17:216-223.
  56. Makary MA, Daniel M. Medical error-the third leading cause of death in the US.. BMJ 2016;353:i2139.
  57. Low R, Wu AW. Veterinary healthcare needs to talk more about error: for the wellbeing of our patients and medical teams.. J Vet Intern Med 2022;36:2199-2202.
  58. Hayes GM, Bersenas AM, Mathews K, Lane WG, LaLonde-Paul DF, Steele A. A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units.. J Vet Emerg Crit Care 2020;30:517-524.
  59. Wallis J, Fletcher D, Bentley A, Ludders J. Medical errors cause harm in veterinary hospitals.. Front Vet Sci 2019;6:12.
  60. Kogan LR, Rishniw M, Hellyer PW, Schoenfeld-Tacher RM. Veterinarians' experiences with near misses and adverse events.. J Am Vet Med Assoc 2018;252:586-595.
  61. Oxtoby C, Ferguson E, White K, Mossop L. We need to talk about error: causes and types of error in veterinary practice.. Vet Record 2015;177:438.
  62. Tucker AL, Spear SJ. Operational failures and interruptions in hospital nursing.. Health Serv Res 2006;41:643-662.
  63. Carayon P, Cassel C, Dzau VJ. Improving the system to support clinician well-being and provide better patient care.. JAMA 2019;322:2165-2166.
  64. Irwin A, Vikman J, Ellis H. ‘No-one knows where you are’: veterinary perceptions regarding safety and risk when alone and on-call.. Vet Record 2019;185:728.
  65. McMillan M. New frontiers for veterinary anaesthesia: the development of veterinary patient safety culture.. Vet Anaesth Analg 2014;41:224-226.
  66. Oxtoby C, Mossop L, White K, Ferguson E. Safety culture: the Nottingham veterinary safety culture survey (NVSCS).. Vet Record 2017;180:472.

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