Unintentional boric acid exposure: a case report and boron level monitoring

Boric acid (BA) is found in various household products. Paediatric intoxication via unusual routes remains a concern. This case report describes an 8-year-old boy who ingested BA through contaminated pasta water, with documented blood and urine boron levels.

An 8-year-old boy consumed homemade pasta prepared with water inadvertently contaminated with a 3% BA solution (estimated intake: 2.7-8.1 g). He presented with nausea and abdominal pain. On admission, routine blood and urine analyses revealed normal creatinine and urea levels. He was admitted for observation, intravenous fluid therapy, and monitoring of boron levels. The patient experienced one episode of vomiting and headache, which resolved with acetaminophen. Serial blood and urine boron levels were measured. The patient's initial plasma boron concentration was 16.5 mg/L, decreasing significantly within 24 h, consistent with BA's pharmacokinetics. Despite the estimated BA intake, the patient remained largely asymptomatic after the initial episode. Follow-up tests one-month post-discharge were normal.

This case highlights the potential for accidental BA ingestion in children and emphasizes the importance of prompt recognition and supportive treatment with intravenous fluids. While blood boron levels can confirm exposure and elimination, correlation with clinical manifestations requires further study. Ingestion of BA doses exceeding 3 g warrants immediate hyperhydration and monitoring. BA is readily absorbed, with renal excretion being the primary route of elimination. Prompt hydration is crucial. A one-month follow-up with clinical evaluation and renal function tests appears sufficient for asymptomatic patients. Further research is needed to better define the toxic dose of BA and its clinical correlation.