Children may be more vulnerable because of relatively increased minute ventilation per kg and failure to evacuate an area promptly when exposed.
Accumulation of formic acid can cause an anion-gap acid-base imbalance. If formalin is ingested, absorption of the methanol stabilizer may contribute to the imbalance and can result in an osmolal gap, as well as an anion gap. In persons who have been previously sensitized, inhalation and skin contact may cause various skin disorders, asthma-like symptoms, anaphylactic reactions and, rarely, hemolysis.
The immune system in children continues to develop after birth, and thus, children may be more susceptible to certain chemicals. Ingestion of aqueous solutions of formaldehyde can result in severe corrosive injury to the esophagus and stomach. Nausea, vomiting, diarrhea, abdominal pain, inflammation of the stomach, and ulceration and perforation of the oropharynx, epiglottis, esophagus, and stomach may occur.
Both formaldehyde and the methanol stabilizer are easily absorbed and can contribute to systemic toxicity. Exposure to low concentrations of formaldehyde vapor can cause eye irritation, which abates within minutes after exposure has ended. Formalin splashed in the eyes can result in corneal ulceration or cloudiness of the eye surface, death of eye surface cells, perforation, and permanent loss of vision; these effects may be delayed for 12 hours or more.
Exposure to formaldehyde vapor or to formalin solutions can cause skin irritation and burns. In sensitized persons, contact dermatitis may develop at very low exposure levels. In survivors of inhalation injury, pulmonary function usually returns to normal. Eye exposure to high concentrations of formaldehyde vapor or formalin can eventually cause blindness. Narrowing of the esophagus and severe corrosive damage to the stomach lining can result from ingesting formalin.
The major concerns of repeated formaldehyde exposure are sensitization and cancer. In sensitized persons, formaldehyde can cause asthma and contact dermatitis. In persons who are not sensitized, prolonged inhalation of formaldehyde at low levels is unlikely to result in chronic pulmonary injury. Adverse effects on the central nervous system such as increased prevalence of headache, depression, mood changes, insomnia, irritability, attention deficit, and impairment of dexterity, memory, and equilibrium have been reported to result from long-term exposure.
Chronic exposure may be more serious for children because of their potential longer latency period. The Department of Health and Human Services has determined that formaldehyde may reasonably be anticipated to be a carcinogen. In humans, formaldehyde exposure has been weakly associated with increased risk of nasal cancer and nasal tumors were observed in rats chronically inhaling formaldehyde.
There is limited evidence that formaldehyde causes adverse reproductive effects. The TERIS database states that the risk of developmental defects to the exposed fetus ranges from none to minimal. Formaldehyde is not included in Reproductive and Developmental Toxicants , a report published by the U.
General Accounting Office GAO that lists 30 chemicals widely acknowledged to have reproductive and developmental consequences. There have been reports of menstrual disorders in women occupationally exposed to formaldehyde, but they are controversial. Studies in experimental animals have reported some effects on spermatogenesis. Formaldehyde has not been proven to be teratogenic in animals and is probably not a human teratogen at occupationally permissible levels.
Formaldehyde has been shown to have genotoxic properties in human and laboratory animal studies producing sister chromatid exchange and chromosomal aberrations. Special consideration regarding the exposure of pregnant women is warranted, since formaldehyde has been shown to be a genotoxin; thus, medical counseling is recommended for the acutely exposed pregnant woman.
Rescuers should be trained and appropriately attired before entering the Hot Zone. If the proper equipment is not available, or if rescuers have not been trained in its use, assistance should be obtained from a local or regional HAZMAT team or other properly equipped response organization. Formaldehyde is a highly toxic systemic poison that is absorbed well by inhalation. The vapor is a severe respiratory tract and skin irritant and may cause dizziness or suffocation. Contact with formaldehyde solution may cause severe burns to the eyes and skin.
Respiratory Protection : Positive-pressure, self-contained breathing apparatus SCBA is recommended in response situations that involve exposure to potentially unsafe levels of formaldehyde vapor. Skin Protection : Chemical-protective clothing is recommended because formaldehyde can cause skin irritation and burns.
Quickly access for a patent airway, ensure adequate respiration and pulse. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible. If victims can walk, lead them out of the Hot Zone to the Decontamination Zone. Victims who are unable to walk may be removed on backboards or gurneys; if these are not available, carefully carry or drag victims to safety.
Consider appropriate management of chemically contaminated children, such as measures to reduce separation anxiety if a child is separated from a parent or other adult. Victims exposed only to formaldehyde vapor who have no skin or eye irritation may be transferred immediately to the Support Zone. All others require decontamination see Basic Decontamination below. If exposure levels are determined to be safe, decontamination may be conducted by personnel wearing a lower level of protection than that worn in the Hot Zone described above.
Stabilize the cervical spine with a collar if trauma is suspected. Administer supplemental oxygen as required. Assist ventilation with a bag-valve-mask device if necessary. Victims who are able may assist with their own decontamination. Remove and double-bag contaminated clothing and personal belongings.
Flush liquid-exposed skin and hair with plain water for 3 to 5 minutes. Wash area thoroughly with soap and water when possible. Use caution to avoid hypothermia when decontaminating children or the elderly. Use blankets or warmers when appropriate. Irrigate exposed or irritated eyes with plain water or saline for 15 minutes. Remove contact lenses if easily removable without additional trauma to the eye. If pain or injury is evident, continue eye irrigation while transferring the victim to the Support Zone.
In cases of formalin ingestion, do not induce emesis. Victims who are conscious and able to swallow should be given 4 to 8 ounces of water or milk. Gastric lavage with a small bore NG tube should be considered if it can be performed within 1 hour after ingestion.
A soda can and straw may be of assistance when offering charcoal to a child. Consider appropriate management of chemically contaminated children at the exposure site. Also, provide reassurance to the child during decontamination, especially if separation from a parent occurs.
If possible, seek assistance from a child separation expert. As soon as basic decontamination is complete, move the victim to the Support Zone. Be certain that victims have been decontaminated properly see Decontamination Zone above. Persons who have undergone decontamination or who have been exposed only to vapor pose no serious risks of secondary contamination.
Support Zone personnel require no specialized protective gear in such cases. Quickly access for a patent airway. Ensure adequate respiration and pulse. Administer supplemental oxygen as required and establish intravenous access if necessary. Place on a cardiac monitor. Watch for signs of airway swelling and obstruction such as progressive hoarseness, stridor, or cyanosis.
If water has not been given previously, administer 4 to 8 ounces of milk or water if the patient is able to swallow. In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, perform cricothyroidotomy if equipped and trained to do so. Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias especially in the elderly. Formaldehyde poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.
How can I reduce formaldehyde levels in my home? When purchasing products that may contain formaldehyde, methods to lower your exposure include: Allow products to off-gas : Remove the packaging from products and allow them to air out before bringing them into your house.
Consider asking the manufacturer or store to leave the product unsealed in their warehouse for a few days before delivery. You may also consider purchasing a floor model where chemicals have already off-gassed. Ventilate your home : Increase the supply of fresh air to lower the concentration of formaldehyde. This can be done by opening windows, using fans or bringing in fresh air through a central ventilation system such as a furnace air exchanger.
Control the heat and humidity : Lower the temperature and humidity in the home through air conditioning and dehumidification. The amount of formaldehyde released goes up with increases in air temperature and humidity.
How can I measure the level of formaldehyde? Ask yourself a few questions, such as: Have you made changes to your home? For example, have you installed new pressed wood materials such as new cabinets, flooring, or furniture? Have you applied coatings or finishing products to floors or other surfaces? Do you have combustion powered appliances that do not vent to the exterior of the home?
Do you or others smoke in the home? If you choose to test your air, there are a couple of ways to do so: Hire an indoor air quality IAQ consultant : While this is the most costly option, hiring a consultant provides you with a variety of testing methods that are not easily available to consumers. In addition, consultants can help you interpret your results. It is important to follow the kit instructions to obtain accurate results. What is an acceptable level of formaldehyde? Cancers by Body Location.
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