Formaldehyde-induced corrosive gastric cicatrization: case report

A patient with poisoning due to formaldehyde ingestion is described. Endoscopy showed severe oesophageal burns and moderate gastric injury. Four weeks later endoscopy and barium examination revealed a normal oesophagus while the distal part of stomach was cicatrized.

A study of respiratory effects from exposure to 2 ppm formaldehyde in healthy subjects

Formaldehyde (FA) is a common indoor air pollutant with irritative properties. It has been suggested that FA may produce physiologic alterations of the respiratory system. To study such responses, 15 nonsmoking, healthy subjects were exposed in a double blind, random manner to 0 and 2 ppm FA for 40 min in an environmental chamber. In addition, the same exposures were repeated on a separate day with the subjects performing moderate exercise (450 kpm/min) for 10 min. Exposures were carried out under controlled environmental conditions (temperature = 23 degrees C, relative humidity = 50%). Pulmonary function was measured before, during, and after exposures using partial and maximal flow-volume curves and airway resistance. Symptom diaries were given to the subjects; upper and lower airway symptoms were recorded for up to 24 hr following exposures. No significant bronchoconstriction was noted in this group. In 3 subjects, sequential measurements of peak flow over a 24-hr period following FA exposure failed to reveal any delayed airway response. On a separate day, 6 healthy subjects failed to demonstrate changes from their baseline responsiveness to methacholine after exposure to 2 ppm FA. Respiratory symptoms were, in general, confined to the upper airways and were mild to moderate in severity. We conclude that short exposures to 2 ppm FA do not result in acute or subacute changes in lung function among healthy individuals either at rest or with exercise. Subjective complaints following such exposures are confined to irritative phenomena of the upper airways.

Formaldehyde exposure and respiratory and related cancers. A case-referent study among Finnish woodworkers

A case-referent study was undertaken to investigate the associations between formaldehyde exposure and respiratory and related cancers. Fifty-seven such cancers from a retrospective cohort of male woodworkers formed the case group. They were matched by year of birth with 171 referents. Exposure to formaldehyde was assessed with job-exposure matrices. The median of the time-weighted average concentration was about 1 ppm, and the mean duration of exposure was 10 years among the exposed. Odds ratios (OR) were calculated for formaldehyde exposure (1.44), peak exposure to formaldehyde (1.26), and exposure to formaldehyde-containing wood dust (1.22). None of the values exceeded unity with statistical significance. Allowance was also made for a 10-year period from the onset of exposure. Birth year, cigarette smoking and exposure to wood dust, chlorophenols, pesticides, and terpenes were controlled by stratification. The adjusted ORs did not change appreciably. The highest OR was 1.95 for formaldehyde exposure without allowance for minimum latency, adjusted for exposure to terpenes. No exposure-response relation was observed for the level, duration, or dose (ppm-years) of formaldehyde exposure. The result is nonpositive and may be explained by absence of effect, by too short a follow-up, or by insufficient power for detecting a mild excess risk.

Pulmonary and neurobehavioral effects of formaldehyde exposure

Two groups of male workers who were exposed to formaldehyde, the first group in phenol-formaldehyde-plastic foam matrix embedding of fiberglass (batt making), and the second in the fixation of tissues for histology, were studied for work-related neuro-behavioral, respiratory, and dermatological symptoms; and for pulmonary functional impairment. Forty-five male fiberglass batt makers who were studied across the initial work-shift after a holiday had average frequencies of combined neurobehavioral, respiratory, and dermatological symptoms of 17.3 for the hot areas and 14.7 for the cold areas of the process. Their symptom counts were significantly greater than those for 18 male histology technicians who averaged 7.3, and for 26 unexposed male hospital workers who averaged 4.8. During their first workshift after holidays, 58% of the batt makers had a decrease in one or more tests of pulmonary function. Nine nonsmokers had decreases more frequently than did 35 smokers; forced expiratory volume in one second FEV1.0 decreased in 16%, diffusing capacity for carbon monoxide (sb) decreased in 30%, forced expiratory flow 25-75 decreased in 16%, and forced expiratory flow) 75-85 decreased in 36%. Thirty-five percent of all 44 men had drops in FEV1.0, forced vital capacity, or in diffusing capacity (sb).

Formaldehyde toxicity. Part II. Review of acute and chronic effects on health

Inhaled formaldehyde has acute effects on the respiratory tract, central nervous system, skin and eyes and also chronic effects on the respiratory tract, particularly on pulmonary function. Formaldehyde has also been associated with adverse reproductive and mutagenic effects, and there is evidence of carcinogenic effects from two important animal studies. Some data, largely indirect, suggest a carcinogenic risk for man. The reactions of some international scientific bodies to the accumulated data are noted, and steps taken by a number of countries to control formaldehyde exposure in the workplace and other environments are discussed.

Formaldehyde toxicity. Part I. Occupational exposure and a report of 5 cases

Formaldehyde is ubiquitous in the occupational, domestic and general environment, and in manufactured and consumer goods. The clinical and radiological findings in 5 shop employees exposed to formaldhyde are presented. Two features are of interest: (i) 1 of the workers developed vomiting, a symptom previously unreported in adults exposed to formaldehyde; and (ii) all 5 victims developed turbinate swelling, apparent clinically and radiologically. The swelling was marked, causing obstruction of the nasal passages, and persisted for some time after most of the sources of exposure had been dealt with. This phenomenon is also previously undocumented.

Formaldehyde in the British chemical industry. An occupational cohort study

This paper reports the mortality experience of a cohort of 7680 men who had first been employed before 1965 in one of six factories in the British chemical or plastics industry where formaldehyde had been manufactured or used. All the jobs undertaken by each man were classified, on the basis of subjective information, into four categories in terms of exposure to formaldehyde. More than 98% of the workforce were traced to the end of 1981. No deaths from nasal cancer were reported (1.07 expected), and no excess mortality was found for cancers at any of the sites previously reported to be possibly associated with formaldehyde. In one factory a significantly high mortality from lung cancer was found (standardised mortality ratio 124; 95% confidence limits 104, 148) when the mortality rates of England and Wales were used as a standard, but not when an adjustment was made based on the local area mortality. Within the factory the increased mortality was limited to men who had been exposed to "high" levels of formaldehyde. There were no trends of increasing mortality with duration of work or interval since first exposure. This result may be a chance finding or reflect the influence of smoking or some other factor. Although a carcinogenic action of formaldehyde seems less likely as an explanation it cannot be excluded. The statistical power of the study to detect various risks of nasal cancer is described.

Acute intravascular hemolysis due to accidental formalin intoxication during hemodialysis

A patient accidentally exposed to formalin during hemodialysis developed acute intravascular hemolysis. In vitro study showed that formalin has direct oxidant action on red blood cells. Formalin intoxication should be recognized as a cause of acute hemolysis during hemodialysis and is not invariably fatal, provided further exposure is stopped in time and the complications prevented.

Formalin toxicity in hydatid liver disease

Two cases of formalin toxicity developed within 5 to 10 minutes of the placement of packs soaked in formalin within hepatic hydatid cysts. Hypotension, severe tachycardia, postoperative anuria, tachypnoea, restlessness, unconsciousness and coma developed. There was no response to the treatment given. Treatment was continued for about 12 hours. The problems associated with the use of formalin are discussed.

[Accidental fatal formaldehyde poisoning]

A previously healthy man accidentally swallowed 20 to 50 ml of Formalin (25%). Relevant clinical findings after the accident were: severe metabolic acidosis, severe disseminated intravascular coagulation and renal failure. He died 7 hours after formaldehyde ingestion-presumably from toxic pulmonary oedema. Relevant post-mortem findings were: massive pulmonary damage (toxic oedema), leather-like thickening of the gastric wall and multiple subendocardial haemorrhages. The treatment of formaldehyde poisoning is briefly discussed.

Proportional mortality patterns among chemical plant workers exposed to formaldehyde

To examine the possible health risks associated with occupational exposure to formaldehyde a proportional mortality analysis was conducted on deaths occurring between 1950 and 1976 among 136 men who had been employed a month or more in one of five formaldehyde-related areas of a large chemical producing plant located in Springfield, Massachusetts, USA. Overall, no statistically significant excesses or deficits in proportional mortality were observed among the formaldehyde-exposed group based on comparisons with both United States men and men from the local county area. In addition, no important differences in mortality were observed among this group when comparisons were made with 456 male decedents from the same plant who had not had a month or more of formaldehyde exposure. Within the calendar period examined, no deaths from sinonasal cancer were observed among the chemical workers studied nor was mention made on any death certificate of sinonasal cancer as a contributory cause of death. No important excesses, trends, or patterns in cancer mortality were observed among white male formadelhyde-exposed workers when consideration was given to age and time period of death, type and duration of formaldehyde exposure, and the lapse period from the onset of the first formaldehyde-related job assignment. Although certain limitations of this study do not allow definite conclusions to be drawn, the results indicate no trends or patterns in proportional mortality that could be directly linked to exposures to formaldehyde.

Formaldehyde induced symptoms in day care centers

A questionnaire study among 70 employees at seven mobile day care centers where urea formaldehyde glued particle board has been used for indoor paneling and among 34 employees at three control institutions selected at random where no particle board has been used as building materials, showed a significantly higher frequency of the following symptoms among the staff at the mobile institutions: mucous membrane irritation, headache, abnormal tiredness, menstrual irregularities and use of analgetics (p less than 0.01). As there was no difference in the age distribution or smoking habits of the two groups working in day care institutions from the same geographical locations, we are, therefore, of the opinion that the differences in the frequency of symptoms discovered must be attributed to the differences in the indoor climate conditions prevalent in the institutions. The median concentration of formaldehyde in the mobile institutions was 0.43 mg/m3 in contrast to a concentration in the control institutions of about 0.08 mg/m3. We assume, therefore, that the higher concentration of formaldehyde in the mobile institutions was a cause of the increased frequency of symptoms among the staff. The National Health Service should be aware of the fact that non-specific symptoms such as headache and abnormal tiredness can be the result of unfavorable indoor climate conditions due to the presence of formaldehyde in building materials.

[Lethal intoxication by formalin during dialysis (author's transl)]

Systems for dialysis are disinfected, among other solutions, by formalin. Residues of formalin may remain in the interior of the system. A lethal intoxication with formalin by transvasal introduction of formalin during the dialysis of patients with nephritic disease cannot be observed very often. Two cases of death at the same time in one system for dialysis make evident that every case of death during dialysis should be investigated. The central symptom in both patients was dyspnea. It is probable that formalin affects the transportation and exchange of oxygen with lethal hemolysis.