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, me tabolic acidosis and oliguria. Death may result from circulation collapse a nd shock. Objective: We present a clinical case history of the successful use of forc ed diuresis with furosemide and intravenous fluid for boric acid poisoning. Subject: A 26-year-old female who attempted suicide by consuming a large qu antity of boric acid. She was brought to the hospital in a state of clouded consciousness, fever and erythema 14 h after ingestion. Method: 3.25 L of intravenous fluid and 100 mg of furosemide were administe red over a period of 4 h in the intensive care unit and the serum and urina ry concentrations of boric acid measured. Results:The elimination rate of boric acid obtained with diuresis was simil ar to that obtained with haemodialysis on a previous occasion when the same patient attempted suicide with boric acid. The patient showed only tempora ry emesis and diarrhoea along with erythema, and was moved to the general w ard 4 h after admission. Although in the general ward the patient's fever p ersisted and nausea, vomiting and headache often recurred, possibly because of an insufficient dose of furosemide, the patient's condition steadily im proved over the 64 h after admission. Conclusion: Forced diuresis without haemodialysis is recommended early afte r admission for boric acid poisoning.