Acute Multiorgan Failure and Death With Formalin Ingestion: A Case Report

ABSTRACT Formalin, an aqueous solution of formaldehyde, is widely used as a disinfectant and tissue preservative. Intentional ingestion is rare because of its strong odor and highly corrosive properties; however, when it occurs, it can lead to severe metabolic acidosis and multi‐organ failure. Given the limited clinical and forensic evidence regarding suicidal formalin ingestion, we report this case and present its complete clinical and toxicological findings due to its rarity. A 53‐year‐old man presented to the emergency department 1 h after ingesting 200 mL of 37% formalin in a suicide attempt. On arrival, he was tachycardic and hypertensive, with marked respiratory distress and a Glasgow Coma Scale (GCS) score of 13. Laboratory evaluation demonstrated severe high–anion gap metabolic acidosis (pH 7.13, HCO 3 − 13 mEq/L, anion gap 23 mEq/L). Upper gastrointestinal endoscopy revealed diffuse corrosive injury, including esophageal erosions and extensive mucosal hemorrhage. He received aggressive supportive management, including intravenous sodium bicarbonate, vasopressors, mechanical ventilation, and hemodialysis. Due to worsening respiratory distress and tachypnea, he was intubated and transferred to the intensive care unit (ICU). Despite these interventions, his respiratory function progressively deteriorated, and he died approximately 12 h after ingestion. Gross autopsy findings showed severe corrosive injury with gastric and intestinal mucosal hemorrhage, pulmonary congestion, and epicardial hemorrhage. Histopathological examination demonstrated submucosal gastric necrosis, acute tubular necrosis of the kidneys, interalveolar hemorrhage in the lungs, and early ischemic changes in the brain. These findings were consistent with multi‐organ failure secondary to formaldehyde toxicity. The clinical presentation, case history, autopsy findings, and histopathological results indicate that the cause of death was multi‐organ dysfunction, including severe respiratory distress and cardiac failure, secondary to ingestion of a formaldehyde‐containing compound. This case highlights the rapid and potentially fatal progression of formalin poisoning and underscores the importance of early recognition and prompt, aggressive supportive management. Increased awareness of its clinical course and pathological manifestations may aid clinicians in timely diagnosis and intervention, potentially improving outcomes.