growing rubber is the major agricultural activity in kerala . rubber plantation workers collect the latex from the trees by tapping , and then coagulate it by mixing with formic acid , which is further processed before sales . as formic acid is easily available to the rubber growing population both suicidal and accidental ingestion is commonly seen . formic acid is also used in other industries such as paper , tanning electroplating , and manufacturing of disinfectants . this is a case study of one patient with accidental formic acid poisoning who was admitted in our hospital . a 39-year - old female patient presented to our a and e department with alleged history of accidental consumption of concentrated formic acid ( 85% ) . there was no history of breathlessness , chest pain , or hoarseness of voice . on examination , she was kept nil per orally , nasogastric tube was not inserted and stomach wash not given . she was started on infusion of proton pump inhibitor and oral sucralfate 15 ml thrice daily . intravenous ( iv ) fluids included 1000 ml of sodium chloride , 500 ml of 5% dextrose , and 500 ml of normal saline . she was also prescribed amoxicillin and clavulanic acid injection 1.2 g iv twice daily empirically . after 4 h , her urine bag showed dark colored urine suggesting of hemoglobinuria and intravascular hemolysis [ figure 1 ] . dark red urine from a patient of formic acid poisoning subsequently , patient had two episodes of vomiting which were bloodstained and her throat pain worsened . by 1 day , patient had complications such as hematemesis , hematuria , and hemoglobinuria . however , her bleeding time , clotting time , and prothrombin time was normal suggesting that hemolysis is related to the degree of acidity . her total white blood cell ( wbc ) counts were 18,900 on day one with predominant polymorph nuclear lymphocytosis . on the 2 day , patient did not have any hematemesis , her hematuria improved and her coagulation profile was normal . multiple whitish patches were noticed in her oral cavity , which was managed symptomatically with local hygiene . on day 4 , multiple ulcers were noted on the soft palate , buccal mucosa , base of tongue and right side of epiglottis [ figure 2 ] . mucosal ulcerations in the oral cavity with informed consent patient was taken for open gastrostomy on day 5 and enteral feeding started [ figure 3 ] . she was regularly followed - up for stricture formation and underwent regular esophagogastroduodenoscopy ( ogd ) at 4 , 8 , and 12 weeks . it is colorless liquid with the pungent odor and the majority of victims are males , with most cases of suicidal intent and minority cases , which are accidental . common complications are acute renal failure , metabolic acidosis , acute respiratory distress syndrome , oral cavity burns , esophageal strictures , gastrointestinal perforation , aspiration pneumonia , sepsis , shock and rarely tracheoesophageal fistula , pneumomediastinum , and chemical injury to the cornea . the patient should be immediately admitted , vomiting should not be induced and gastric lavage should not be attempted . if severe gastrointestinal hemorrhage is seen , no steroids should be given as it may precipitate impending perforation of the gut wall . high doses of folinic acid ( 1 mg / kg iv bolus followed by 6 doses of 1 mg / kg iv doses at 4 hourly intervals ) should be given in severe poisoning . folinic acid acts by enhancing formate degradation in the liver . hemodialysis should be considered if electrolyte imbalance is uncorrectable . daily urine output , serum creatinine , and serum potassium levels should be monitored to detect early onset of acute renal failure . patient has to be kept nil per orally and iv fluids should be administered to counter shock . pain relief should be done with viscous lignocaine and oral morphine along with light sedation if required . long - term complications include esophageal stricture , for which reparative surgery should be done if required . in a patient with formic acid poisoning , gastrointestinal perforation , hematemesis , respiratory distress , hematuria are associated with increased mortality . increasing age , ph < 7.3 , and hematemesis are risk factors for increased morbidity . metabolic acidosis can be corrected with administration of iv bicarbonate during initial few hours to reduce the associated morbidity and mortality . easy availability should be curtailed by enforcing remedial measures . spreading the knowledge of side - effects of formic acid , both acute , and
among the workers in a rubber plantation in south india , ingestion of formic acid either accidentally or with suicidal intention is a common problem . 
 formic acid is diluted and used for coagulation of rubber latex . 
 easy availability makes formic acid a common poison . 
 the aim of this article is to study the case of formic acid poisoning , its complications and management . 
 patient was managed symptomatically . 
 antidote was not used and no nasogastric aspiration was done . 
 patient had dysphagia ; nutrition was maintained with open gastrostomy done on day 5 and subsequent enteral feeding . measures to prevent anticipated complications were undertaken . 
 stricture of the esophagus is a common complication leading to long - term morbidity . 
 after initial management , all patients should be on follow - up for prevention and management of strictures . 
 workers should be educated on complications of formic acid poisoning and easy availability should be curtailed by enforcing remedial measures .