Carbon monoxide poisoning and pulmonary injury from the mixture of formic and sulfuric acids

Schneir, Aaron; Rentmeester, Landen L.

doi:10.3109/15563650.2016.1157723

Cited by 8 publications

(12 citation statements)

References 29 publications

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“…We report a suicidal patient who survived and made a full recovery after combining formic and sulfuric acids to produce CO resulting in severe toxicity. This case, unfortunately, represents one instance of an increasingly common method by which individuals have used this dehydration reaction to liberate CO with the suicidal intention [9][10][11][12][13][14][15]. While the mixture of sulfuric acid and formic acid has not historically seen much use as a method of self-harm, it has been employed with increasing frequency due to its popularization by online websites and forums.…”

Section: Discussionmentioning

confidence: 99%

Carbon Monoxide Poisoning With Concomitant Mucosal Injury and Chemical Pneumonitis Using Sulfuric and Formic Acids in a Self-Harm Attempt

Lewis

DeVore

Gaines

et al. 2021

Cureus

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The intentional liberation of carbon monoxide through the dehydration of formic acid has been reported with increasing frequency in the literature as a method of self-harm. Online forums have popularized this method of self-harm due to the ease of access of the required reagents, as well as the ability to perform the reaction under ambient conditions. The basis of this method of suicide is the use of sulfuric acid as a dehydrating agent, leading to the decomposition of formic acid into carbon monoxide gas. In addition to the exposure to carbon monoxide liberated by this reaction, the relatively high vapor pressure of formic acid can inadvertently lead to its inhalation and subsequently cause damage to the aerodigestive tract. We report a 21-year-old male who presented with manifestations of acute carbon monoxide poisoning and concomitant chemical pneumonitis. Increased awareness and understanding of this method of self-harm is critical in ensuring appropriate precautions are taken when caring for these individuals.

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Section: Discussionmentioning

confidence: 99%

Carbon Monoxide Poisoning With Concomitant Mucosal Injury and Chemical Pneumonitis Using Sulfuric and Formic Acids in a Self-Harm Attempt

Lewis

DeVore

Gaines

et al. 2021

Cureus

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“…Since Dr. Nitschke’s CO generator first gained media attention in 2003, eight cases of suicides and attempted suicides have been described in the literature; all carried out by males between the ages of 21 and 31 (7,15 –21). Our case is an outlier in this respect as the decedent was 44 years old.…”

Section: Discussionmentioning

confidence: 99%

“…The seven cases in the United States include previous case reports, our present case, a second case investigated by our facility the following year, and two fatal incidents described in public news sources (22,23), one of which has been corroborated by autopsy report (Humboldt County Sheriff’s Office, personal communication, July 30, 2018). Of these 13 cases, two individuals attempting suicide survived with COHb levels recorded at 20.8% (16) and 36.8% (21) upon arrival at the hospital. The CO generators used in each case varied greatly in design and complexity, with one even incorporating a timer so that the formic and sulfuric acids would mix while the subject was asleep (19).…”

Section: Discussionmentioning

confidence: 99%

“…As CO is an odorless, nonirritating gas, the development of pharyngitis, hemoptysis, or ARDS is an unexpected presentation of CO exposure. In five of the case reports, first responders arriving at the scene described a chemical odor which is likely attributable to formic acid vapor (7,15,18,20,21). An often overlooked complication of this method of generating CO is that while CO itself is an odorless, nonirritating gas, liquid formic acid produces noxious fumes upon exposure to air which cause irritation of the mucous membranes and damage to the respiratory tract (15,18,21).…”

Section: Discussionmentioning

confidence: 99%

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Suicidal Carbon Monoxide Poisoning by Formic and Sulfuric Acids

Kreutz¹,

Danielsen²,

Quinton³

2019

Academic Forensic Pathology

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In 1987, a case report was published in the German journal Archiv für Kriminologie describing an apparently novel method of suicide in which the decedent produced a lethal amount of carbon monoxide by mixing formic acid and sulfuric acid. This method of chemical suicide remained obscure until 2003, when Dr. Philip Nitschke, a vocal supporter of assisted suicide, began promoting a homemade carbon monoxide generator which utilized this same chemical reaction. In 2006, he coauthored The Peaceful Pill Handbook, which provided further details about how the device worked. Pro-voluntary euthanasia organizations and online forums continue to provide information about this method, promoting it as painless and efficient. There have been nine case reports of suicides and attempted suicides using this chemical reaction, with five reported in Europe, three in the United States, and one in Taiwan. Two additional cases were reported in news articles that did not correspond to known case reports, indicating that this method of suicide is more common than the scientific literature would suggest. We present the case of a 44-year-old male who learned about this method of chemical suicide online and filmed the suicidal act while verbally recording carbon monoxide levels prior to losing consciousness.

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“…One such method involves combining formic acid with sulfuric acid, which produces CO. 1 A total of 11 such reported cases were found in the literature, one of which was an outdoor occupational exposure. [2][3][4][5][6][7][8][9][10] All the other cases were acts of suicide in enclosed surroundings including home spaces and, in one particular case, inside a car. We report a patient who generated CO from a sulfuric and formic acid mixture in her car in an attempt to commit suicide.…”

Section: Introductionmentioning

confidence: 99%

An Unusual Case of Carbon Monoxide Poisoning from Formic and Sulfuric Acid Mixture

Ershad

Melisiotis

Gaskill

et al. 2019

Clinical Practice and Cases in Emergency Medicine

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Formic acid, when combined with sulfuric acid, gets dehydrated to form carbon monoxide (CO). A 27-year-old female was found unconscious inside a car, next to a container with a mixture of sulfuric acid and formic acid. Concentrations of up to 400 parts per million of CO were measured inside the car post ventilation. Serum carboxyhemoglobin level was 15% after receiving 100% oxygen for two hours. The patient received hyperbaric oxygen therapy after which she was extubated with normal mental status. On follow-up after three months, she demonstrated neurocognitive abnormalities suggestive of delayed neurological sequelae from CO exposure.

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Carbon monoxide poisoning and pulmonary injury from the mixture of formic and sulfuric acids

Abstract: The case highlights the potential toxicity, particularly from inhaled carbon monoxide and formic acid, with this method of suicide.

Cited by 8 publications

References 29 publications

Carbon Monoxide Poisoning With Concomitant Mucosal Injury and Chemical Pneumonitis Using Sulfuric and Formic Acids in a Self-Harm Attempt

Carbon Monoxide Poisoning With Concomitant Mucosal Injury and Chemical Pneumonitis Using Sulfuric and Formic Acids in a Self-Harm Attempt

Suicidal Carbon Monoxide Poisoning by Formic and Sulfuric Acids

An Unusual Case of Carbon Monoxide Poisoning from Formic and Sulfuric Acid Mixture

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