Boric Acid Poisoning

Aka: Boric Acid Poisoning, Boric Acid, Othorboric Acid, Boric Acid Toxicity, Borate, Borax

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II. Background

  1. Boric Acid is a boron compound used as an Insecticide (rodents, ants), as well as a topical disinfectant
  2. Related Borates have been used in mouthwash and toothpaste
  3. Borates are also used in industrial products (glazes, enamels, glass fibers)

III. Mechanism: Poisoning

  1. Poisoning is typically by ingestion, but may also be absorbed via abraded skin
  2. Mitochondrial injury by boron hydroxyl complexes
  3. Ingestion <100 mg is typically asymptomatic
  4. Severe symptoms at >50 mg/kg
  5. Lethal dose: 15-20 g (2-3 g for infant)
  6. Renal Excretion
  7. Half-Life: 10-20 hours
  8. Volume of Distribution: 0.17 to 0.5 L/kg

IV. Findings: Poisoning

  1. Cardiovascular Effects
    1. Hypotension
  2. Neurologic Effects
    1. Headache
    2. Lethargy to Coma
    3. Lightheadedness
    4. Irritabilty
    5. Seizure
  3. Gastrointestinal Effects
    1. Nausea
    2. Vomiting (blue-green appearance)
    3. Diarrhea (blue-green appearance)
    4. Abdominal Pain
    5. Mucositis
  4. Dermatologic Effects
    1. Diffuse skin erythema over face, axilla, inguinal region
    2. Rash progresses to Desquamation
  5. Renal Effects
    1. Acute Kidney Injury with Anuria (due to Acute Tubular Necrosis)

V. Labs

  1. Comprehensive Metabolic Panel
    1. Liver Function Test abnormalities
    2. Metabolic Acidosis with Anion Gap
    3. Osmolar Gap
  2. Boric Acid Levels
    1. Measured in urine and whole blood

VI. Management

  1. See Unknown Ingestion
  2. Decontamination
    1. Remove contaminated clothing and wash skin with soap and water (topical exposure)
    2. Consider Activated Charcoal (ingestion)
  3. ABC Management
  4. Intravenous Fluid
    1. Promotes more rapid excretion
  5. Vasopressors (e.g. Norepinephrine) indicated in Hypotension refractory to Intravenous Fluids
  6. Hemodialysis Indications
    1. Severe Toxicity
    2. Acute Kidney Injury with Anuria
  7. Upper Endoscopy Indications
    1. Large ingestion with persistent gastrointestinal symptoms

VII. References

  1. Tomaszewski (2021) Crit Dec Emerg Med 35(2): 28
  2. Leikin (1995) Poisoning and Toxicology, Lexicomp, p. 870-1

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