Usefulness of forced diuresis for acute boric acid poisoning in an adult.
BACKGROUND
Boric acid is generally not recognized as a poisonous substance. However, boric acid has potentially fatal actions such as hypotension, metabolic acidosis and oliguria. Death may result from circulation collapse and shock.


OBJECTIVE
We present a clinical case history of the successful use of forced diuresis with furosemide and intravenous fluid for boric acid poisoning.


METHODS
A 26-year-old female who attempted suicide by consuming a large quantity of boric acid. She was brought to the hospital in a state of clouded consciousness, fever and erythema 14 h after ingestion.


METHODS
3.25 L of intravenous fluid and 100 mg of furosemide were administered over a period of 4 h in the intensive care unit and the serum and urinary concentrations of boric acid measured.


RESULTS
The elimination rate of boric acid obtained with diuresis was similar to that obtained with haemodialysis on a previous occasion when the same patient attempted suicide with boric acid. The patient showed only temporary emesis and diarrhoea along with erythema, and was moved to the general ward 4 h after admission. Although in the general ward the patient's fever persisted and nausea, vomiting and headache often recurred, possibly because of an insufficient dose of furosemide, the patient's condition steadily improved over the 64 h after admission.


CONCLUSIONS
Forced diuresis without haemodialysis is recommended early after admission for boric acid poisoning.
Teshima
D
D
Department of Hospital Pharmacy, Faculty of Medicine, Kyushu University, Maidashi, Fukuoka, Japan. dteshima@st.hosp.kyushu-u.ac.jp
Taniyama
T
T
Oishi
R
R
D000328:Adult; D001888:Boric Acids / Q000097:blood / Q000506:poisoning* / Q000652:urine; D003422:Critical Care; D004231:Diuresis; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D011041:Poisoning / Q000188:drug therapy / Q000473:pathology; D013405:Suicide; D013997:Time Factors
D001888:Boric Acids; D004232:Diuretics; D005665:Furosemide; C032688:boric acid