Severe and Lethal Acetic Acid Poisonings: A Multicentre Case Series

Objective: Acetic acid is often used in Russia to preserve vegetables and is easily available to the general public. During recent years about 10% of all poisoning cases reported to nine poisons centres were due to acetic acid exposures and the mortality rate has previously been estimated as 6%. These acute poisonings represent a serious toxicological problem. Prediction of severity and outcome after acetic acid poisonings has been made but the corrosive damage is dependent on amount, concentration and also route and time of exposure. An estimated lethal dose of acetic acid (70%) per os is 50-70 ml. No previous case series regarding acetic acid ingestions have been published. Case Series: This retrospective multicentre case series includes all patients reported to nine Russian poisons centres (covering 6 million inhabitants) due to ingestion of acetic acid. Data were collected during 1998--2000 and included age, sex, dose, route of exposure, concomitant substances, symptoms and vital signs, laboratory values, time (number of days) in the intensive care unit (ICU), hospital stay (number of days) and outcome. Entrance into the study required a diagnosis of acute acetic acid poisoning. A total of 29601 patients were admitted to hospital because of acute poisonings. Corrosive liquids were the poisoning agent in two 133 cases (7.2%) and one in 84 cases (3.7%) were due to acetic acid ingestions. Mean hospital stay in patients poisoned by acetic acid was 10.12 plus or minus 5.54 days and mean time spent at the ICU was 5.60 plus or minus 2.35 days. The total mortality rate was 832/29 601 (2,8%) and corrosives were the causing agents in 230 (28%) of these lethal cases with 157 (19%) due to acetic acid ingestion. Main causes of death after acetic acid poisonings were acute renal feilure, disseminated intravascular coagulation and acute prehospital bleeding. Conclusions: Acute acetic acid poisonings require extensive treatment and multiple days of observation at the ICU. Ingestions of acetic acid often lead to severe intoxications and the mortality is high.