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ACUTE EXPOSURE INFORMATION

  1. NOTE: This topic is limited to inhalation and/or dermal/ocular exposure of formaldehyde due to occupational/environmental exposure. Refer to the FORMALIN management following an ACUTE ingestion/instillation of formalin.
  1. SOURCES: Formaldehyde is a water-soluble and colorless gas at room temperature. Pure formaldehyde is not sold commercially because of its tendency to polymerize. It is most commonly available as formalin, a liquid that is created by mixing formaldehyde and water (usually 37 g of formaldehyde gas to 100 mL solution). Because this solution will polymerize, 10% to 15% of methanol (stabilized) is added. Other aqueous solutions of formaldehyde are referred to as unstabilized (methanol-free), and the solutions may contain n-butanol, ethanol, or urea. Formaldehyde is used in many manufacturing processes (particularly plastics and resins) and as a tissue fixative and embalming agent. It may also be used in the disinfection of hemodialysis machines. Formaldehyde is also used to manufacture urea-formaldehyde, which is found in building insulation and particle boards. It can often be measured at low levels indoors.
  1. TOXICOLOGY: Formaldehyde is metabolized to formic acid by the catalytic action of alcohol dehydrogenase and formate with eventual conversion to carbon dioxide and water via a folate-dependent pathway. Formaldehyde exposure can occur in various ways, and only mild symptoms are expected in very low concentrations. Refer to the FORMALIN management following an ACUTE ingestion/instillation of formalin.
  1. EPIDEMIOLOGY: Uncommon poisoning that can result in significant morbidity.
  1. WITH POISONING/EXPOSURE
    1. TOXICITY: Formaldehyde may be irritating to the eyes, skin, and mucous membranes. Health effects from environmental or occupational exposure can come from the off-gassing of formaldehyde from building materials. The effects may include headache; nausea; burning of the eyes, nose, and throat; skin rashes; coughing; and chest tightness. Sensitive individuals may have reactions at concentrations as low as 0.1 parts per million (ppm).
    1. INHALATION: Respiratory tract irritation, rhinitis, anosmia, cough, dyspnea, wheezing, tracheitis, bronchitis, laryngospasm, pulmonary edema, headache, weakness, dizziness, and palpitations may result from inhalation.
    1. DERMAL: Dermatitis, brownish discoloration of the skin, urticaria, and pustulovesicular eruptions may develop from dermal exposure.
    1. OCULAR: Irritation, lacrimation, and conjunctivitis may develop with exposure to vapors. Eye exposure to solutions with high formaldehyde concentrations may produce severe corneal opacification and loss of vision. Solutions containing low formaldehyde concentrations may produce transient discomfort and irritation.
    1. CHRONIC: Chronic exposures may increase the risk of cancer and occupational asthma.
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