Context: The inhalation of carbon monoxide produced by the incomplete combustion of carbon remains a popular method of suicide. A much less common method of producing carbon monoxide for suicide is by mixing formic and sulfuric acids.
Case details: We describe a patient who attempted suicide by mixing formic and sulfuric acids. He presented with a depressed level of consciousness, chemical burns of his airway and skin, and respiratory distress. He was found to have a metabolic acidosis, a carboxyhemoglobin of 36.8%, hyperkalemia, and rhabdomyolysis. His hospital course was notable for copious pulmonary secretions and hypoxia, but he ultimately recovered with supportive care.
Discussion: The case highlights the potential toxicity, particularly from inhaled carbon monoxide and formic acid, with this method of suicide.
Keywords: Carbon monoxide; carboxyhemoglobin; chemical pneumonitis; rescuer; suicide.