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Toksisitas Formalin
Toksisitas Formalin
l c 2000 Nature
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Introduction
Formaldehyde is a water-soluble, colourless, pun- occur that direct formate to various other pathways
gent, irritating and highly reactive gas. Forty percent including the citric acid pathway where it can be
solution of formaldehyde in water is known as utilised for energy need, releasing carbon dioxide
formalin."2 In medicine, formalin is used in the and water.'3
preservation of surgical specimens, for the treatment
of uncontrolled intravesical hemorrhage3"4 and radia-
tion-induced hemorrhagic proctitis5- 10 and cystitis, Metabolism and excretion
and to prevent hydatid cysts dissemination.1"
It is also a physiological intermediary metabolite The metabolic sequence of formaldehyde is identical
in mammals. The endogenous formaldehyde is in all mammalian species. It is rapidly metabolised to
rapidly metabolised to formate or enters the one- formic acid by several enzyme systems, including the
carbon pool via tetrahydrofolate.1 Formate, as the formaldehyde dehydrogenase (FDH) complex dis-
sodium salt, is one of the simplest endogenous tributed in several tissues, or a hydrogen peroxide/
forms of carbon in man and is the intermediate in catalase system (Figure 1). FDH is involved specifi-
many anabolic and catabolic reactions. Formate or
cally with the oxidation of formaldehyde and has been
formaldehyde has been shown to be involved in identified in human liver and erythrocytes. FDH is
single carbon transfers from many essential amino also involved in the release of formate by cleavage of
acids including glycine, histidine, tryptophan and the thio ester with glutathione. The efficiency of
serine and in the synthesis of purines, pyrimidines, formate metabolism by catalase has been strongly
methionine and cholase.12 The tetrahydrofolic acid linked to the hepatic concentration of tetrahydrofo-
pathway is the primary means through which the late. In vitro studies with human tissue have also
above metabolism occurs. Once formate has entered shown that functionally related aldehyde dehydro-
into the one-carbon unit pool, numerous reactions genase and catalase, which are not dependent on
glutathione, are both capable of converting formalde-
hyde to formate."3
*CorTespondence: Dr CK Pandey, Department of Anaesthesiology In humans and monkeys, formic acid is slowly
and Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow 226014, India metabolised to carbon dioxide and water by an
Received 4 November 1999; accepted 20 May 2000 enzymatic reaction, which depends on folate. Folate
Toxicity of ingested formalin and its management
CK Pandey et al m
361
References
1 Koppel C, Baudisch H, Schneider V, Ibe K. Suicidal 17 Witek TJ, Tosum T. Formaldehyde concentration in the
ingestion of formalin with fatal complications. Intensive blood of humans and Fisher 344 rats exposed to
Care Medicine 1990; 16: 212-214. formaldehyde under controlled conditions. American
2 Modi NJ. Modi's Textbook of Medical Jurisprudence and Industrial Hygiene Association Journal 1985; 46 (1): 1-
Toxicology, 19th edn. N.M. Tripathi Pvt. Ltd. Publishers, 3.
Bombay, 1975. 18 McMartin KE, Martin-Amat G, Makar AB, Tephly TR.
3 Fair WR. Formalin in the treatment of massive bladder Methanol poisoning. Role of formate metabolism in the
hemorrhage. Techniques, results and complications. monkey. Journal of Pharmacology and Experimental
Urology 1974; 3: 573-576. Therapeutics 1977; 201 (3): 564-572.
4 Spiro LH, Hecht H, Horowitz A, Orkin L. Formalin 19 Heck HD, et al. Methanol. Journal ofApplied Toxicology
treatment for massive bladder hemorrhage Complica- 1994; 14(4): 309-313.
tions. Urology 1973; 2: 669-671. 20 Myers JA, Mall J, Doolas A, Jakate SM, Saclarides TJ.
5 Seow-Choen F, Goh HS, Eu K-W, Tay S-K. A simple Absorption kinetics of rectal formalin instillation. World
and effective treatment for hemorrhagic radiation Journal of Surgery 1997; 21: 886-889.
proctitis using formalin. Disease of Colon and Rectum 21 Kilburn Kaye H, et al. Pulmonary and neurobehavioral
1993; 36: 135-138. effects of formaldehyde exposure. Archives of Environ-
6 Roche B, Chautems R, Marti MC. Application of mental Health 1985; 40 (5): 254-260.
formaldehyde for treatment of hemorrhagic radiation- 22 Kilburn Kaye H. Neurobehavioral impairment and
induced proctitis. World Journal of Surgery 1996; 20: seizures from formaldehyde. Archives of Environmental
1092-1095. Health 1994; 49 (1): 37-44.
7 Counter SF, Froese DP, Hart MJ. Prospective evaluation 23 Patterson BP, et al. Occupational hazards of hospital
of formalin therapy for radiation proctitis. American personnel. Annals of Internal Medicine 1985; 102: 658-
Journal of Surgery 1999; 177 (5): 396-398. 680.
8 Saclarides TJ, King DG, Franklin JL, Doolas A. Formalin 24 Breysse PA. The health cost of "tight" homes. Journal of
instillation for refractory radiation-induced hemorrha- American Medical Association 1981; 245: 267-268.
gic proctitis. Report of 16 patients. Disease of Colon and 25 Peck SM, Palitz LL. Sensitization of facial tissues with
Rectum 1996; 39 (2): 196-199. urea-formaldehyde resin. Journal of American Medical
9 Mathai V, Seow-Choen F. Endoluminal formalin Association 1956; 160: 1226-1227.
therapy for hemorrhagic radiation proctitis. British 26 The health hazards of formaldehyde. Lancet 1981; 2
Journal of Surgery 1995; 82 (2): 190. (8252): 926-927.
10 Biswal BM, et al. Intrarectal formalin application, an 27 Heck HA, Casanova M, Starr TB. Formaldehyde toxicity
effective treatment for grade III hemorrhagic radiation - new understanding. Critical Reviews in Toxicology
proctitis. Radiotherapy Oncology 1995; 35 (3): 212-215. 1990; 20 (6): 397-326.
11 Agarwal AR, Garg RL. Formalin toxicity in hydatid liver 28 Kane LE, Alarie Y. Sensory irritation to formaldehyde
disease. Anaesthesia 1983; 38: 662-665. and acrolein during single and repeated exposures in
12 Krebs HA, Hems R, Tyler B. The regulation of folate and mice. American Industrial Hygiene Association Journal
methionine metabolism. Biochemical Journal 1976; 158 1977; 38 (10): 509-522.
(2): 341-353. 29 Cohen N, Modai D, Khalil A, Golik A. Acute resins
13 Boeniger MF. Formate in urine as a biological indicator phenol formaldehyde intoxication. A life -threatening
of formaldehyde exposure: a review. American Industrial occupational hazard. Human Toxicology 1989; 8 (3):
Hygiene Association Journal 1987; 48 (11): 900-908. 247-250.
14 McMartin KD, Martin-Amat G, Noker PE, Tephly TR. 30 Beall JR, Ulsamer AG. Formaldehyde and hepatotoxicity:
Lack of role of formaldehyde in methanol poisoning in a review. Journal of Toxicology and Environmental
the monkey. Biochemical Pharmacology 1979; 28: 645- Health 1984; 13: 1-21.
649. 31 Munoz-Navas M, Garcia-Villarreal L. Caustic colitis due
15 Clay KL, Murphy RC, Watkins WD. Experimental to formalin enema. Gastrointestinal Endoscope 1992;
methanol toxicity in the primate. Analysis of metabolic 38(4): 521.
acidosis. Toxicology Applied Pharmacology 1975; 42: 32 Kochhar R, Nanda V, Nagi B, Mehta SK. Formaldehyde -
1929-1939. induced corrosive gastric cicatrization: case report.
16 Rietbrock N, Henken W, Abshagen V. Folate-catalyzed Human Toxicology 1986; 5 (6): 381-382.
elimination of formic acid in methanol poisoning. 33 Hawley CK, Harsch HH. Gastric outlet obstruction, as a
Biochemical Pharmacology 1971; 20 (10): 2613-2622. late complication of formaldehyde ingestion: a case
Toxicity of ingested formalin and its management
CK Pandey et al
366
report. American Journal of Gastroenterology 1999; 94 35 Burkhat KK, Kulig KW, McMartin KE. Formate levels
(8): 2289-2291. following a formalin ingestion. Veterinary and Human
34 Sidhu KS, Sidhu JS. An alleged poisoning with Toxicology 1990; 32 (2): 135-137.
methanol and formaldehyde. Veterinary and Human
Toxicology 1999; 41 (4): 237-242.