PRODUCTS

BORIC ACID

CAS NO:10043-35-3
EC NO:233-139-2

SYNONYMS:
BORIC ACID; Orthoboric acid; 10043-35-3; Boracic acid; Borofax; Boron hydroxide; Boron trihydroxide; Boric acid (H3BO3); Three Elephant; Basilit B; Trihydroxyborone; Flea Prufe; Super Flea Eliminator; 11113-50-1; Orthoboric acid (B(OH)3); Orthoborsaeure; Boric acid (BH3O3); Borsaeure; Borsaure; Trihydroxyborane; Acidum boricum; Dr.'s 1 Flea Terminator DT; Boric acid (VAN); Bluboro; Dr.'s 1 Flea Terminator DFPBO; Dr.'s 1 Flea Terminator DF; Collyrium Eye Wash; Dr.'s 1 Flea Terminator DTPBO; NCI-C56417; MFCD00011337; B(OH)3; trihydroxidoboron; Ant flip; Homberg's salt; UNII-R57ZHV85D4; NSC 81726; Boric acid (TN); (10B)Orthoboric acid; Boracic acid, Orthoboric acid; R57ZHV85D4; CHEBI:33118; [B(OH)3]; NSC-81726; NCGC00090745-02; Optibor; DSSTox_CID_194; Orthboric Acid; Kjel-Sorb™ Solution; DSSTox_RID_75425; DSSTox_GSID_20194; Borsaure [German]; Boric acid, 99+%, extra pure; Caswell No. 109; Boron, Reference Standard Solution; Boric acid, 99.5%, for analysis; Kjel-sorb; Kill-off; ortho-boric acid; Boric acid [USAN:JAN]; hydrogen orthoborate; BO3; CCRIS 855; Niban Granular Bait; CAS-10043-35-3; HSDB 1432; Boric acid [JAN:NF]; BORIC ACID, ACS; EINECS 233-139-2; Boric acid, 99.99%, (trace metal basis), extra pure; EPA Pesticide Chemical Code 011001; Orthoboric acid (H3BO3); hydrogen borate; Orthoborc acd; AI3-02406; Boric acid, 99.5%, for molecular biology, DNAse, RNAse and Protease free; Boric acid flakes; Boric Acid, Powder; Bluboro (Salt/Mix); Boric Acid, Granular; Boric acid ACS grade; PubChem10918; ACMC-1BSON; Boric acid, Puratronic?; WLN: QBQQ; Boric acid, ACS reagent; Heptaoxotetra-Borate(2-); bmse000941; Boric acid (JP15/NF); Boric acid (JP17/NF); Acidum boricum (Salt/Mix); EC 233-139-2; Boric acid, NF/USP grade; H3BO3; Boric acid, biochemical grade; BIDD:ER0252; CHEMBL42403; INS NO.284; Boric acid Electrophoresis grade; Collyrium Eye Wash (Salt/Mix)

Boric Acid is a weakly acidic hydrate of boric oxide with mild antiseptic, antifungal, and antiviral properties. The exact mechanism of action of boric acid is unknown; generally cytotoxic to all cells. It is used in the treatment of yeast infections and cold sores.Boric acid is an odorless white solid. Melting point 171°C. Sinks and mixes with water. (USCG, 1999)Boric acid is a member of boric acids. It has a role as an astringent. It is a conjugate acid of a dihydrogenborate.Colourless, odourless, transparent crystals or white granules or powder; slightly unctuous to the touch; occurs in nature as the mineral sassolite.ODOURLESS COLOURLESS CRYSTALS OR WHITE POWDER.Colorless, transparent crystals or white granules or powder.Boric acid decomposes in heat above 100 °C forming boric anhydride and water.Slightly unctuous to touch; volatile with steam; solubility in water increased by hydrochloric, citric or tartaric acids.Boric acid will form soluble salts with monovalent cations (e.g. Na2B407.1OH20, 6% in water) and insoluble salts with divalent cations (e.g. CaB407.6H20, almost insoluble in cold water).The substance is included in rectal suppositories for hemorrhoids.Aqueous solutions of boric acid are used topically for ophthalmic irrigation to cleanse, refresh, and soothe irritated eyes. Aqueous solutions of boric acid also are used for removal of loose foreign material, air pollutants (e.g., smog, pollen), or chlorinated water.Boric acid, borates and perborates have been used as mild antiseptics or bacteriostats in eyewashes, mouthwashes, burn dressings, and diaper rash powders; however, the effectiveness of boric acid has largely been discredited.Antibacterial and antifungal. Used chiefly in aqueous solutions or powders for external use.A double-blind comparison was made of the use of 14 daily intravaginal gelatin capsules containing 600 mg of boric acid powder versus the use of identical capsules containing 100,000 U nystatin diluted to volume with cornstarch for the treatment of vulvovaginal candidiasis albicans. Cure rates for boric acid were 92% at 7 to 10 days after treatment and 72% at 30 days, whereas the nystatin cure rates were 64% at 7 to 10 days and 50% at 30 days. The speed of alleviation of signs and symptoms was similar for the two drugs. There were no untoward side effects, and cervical cytologic features were not affected.The chronic use of boric acid in rectal suppositories and in vaginal deodorants carries the risk of intoxication.Borax and boric acid used in powders and ointments have resulted in serious poisonings and death.An outbreak of an illness in a newborn nursery consisting of vomiting, diarrhea, dehydration, and exfoliative dermatitis was mistakenly thought to be due to an infectious agent because Staphylococcus aureus was cultured from the nose, throat, and feces in two patients. The clinical picture was similar to Ritter's disease. However, because S. aureus was not found in other hospital cultures, boric acid toxicity was subsequently considered. It was discovered as a contaminant of the infant formula. Three infants died.Boric acid enhanced action of hypnotics, but devoid of activity itself.Patients using boric acid ophthalmic solutions should be advised to consult a physician if ocular pain or visual changes occur, they experience continued ocular redness or irritation, or the condition worsens or persists. Patients with open wounds in or near the eyes should be advised to seek immediate medical treatment.The fatal dose /in humans/ is thought to be 2000-3000 mg for infants, 5000-6000 mg for children, and 15,000-20,000 mg for adults.Boric acid exhibits minimal bacteriostatic and antifungal activities [L2140]. Boric acid is likely to mediate antifungal actions at high concentrations over prolonged exposures [A32457].Boric Acid is a weakly acidic hydrate of boric oxide with mild antiseptic, antifungal, and antiviral properties. The exact mechanism of action of boric acid is unknown; generally cytotoxic to all cells. It is used in the treatment of yeast infections and cold sores.Boric acid is well absorbed from the gastrointestinal tract, open wounds, and serous cavities but displays limited absorption in intact skin [L2140].Regardless the route of administration, boric acid predominantly undergoes rapid renal excretion of >90% of total administered dose as unchanged form. Small amounts are also excreted into sweat, saliva, and feces. Following administration as ointment, urinary excretion of boric acid accounted for only 1% of the administered dose [L2140].Volume of distribution ranges from 0.17 to 0.5 L/kg in humans, where large amounts of boric acid are localized in brain, liver, and kidney [L2140].A case report of acute boric acid poisoning following oral ingestion of 21 g of boric acid presents the total body clearance of 0.99 L/h before hemodialysis [A32450].Boric acid is readily absorbed from GI tract, serous cavities, and abraded or inflamed skin. It does not penetrate intact skin. Approximately 50% of given dose is excreted within 24 hr. During chronic administration, plateau in urinary excretion is reached only after 2 wk. ... Large amounts of boric acid are localized in brain, liver, and kidney. ... Intracytoplasmic inclusions in pancreas /have been noted/ in fatal cases. /Boric acid/Metabolism of inorganic borates by biological systems is not feasible owing to the excessive energy (523 kJ/mol) required to break the boron-oxygen bond. Inorganic borates, in low concentrations, convert to boric acid at physiological pH in the aqueous layer overlying mucosal surfaces prior to absorption. This is supported by the evidence in both human and animal studies, where more than 90% of the administered dose of borate is excreted as boric acid. There is evidence in both in vitro and in vivo systems that boric acid has an affinity for cis-hydroxyl groups, and this may be the mechanism that explains the biological effects of boric acid. However, this attachment is known to be reversible and concentration dependent, responding to clearance mechanisms.According to human cases of poisoning, the elimination half-life of boric acid ranges from 13 to 24 hours [A32450, L2140].The kinetics of elimination of boron have been evaluated in human volunteers given boric acid via the intravenous and oral routes. The half-life for elimination was the same by either route in these studies and was approximately 21 hr.In humans, the reported excretion half-life is between 13 and 21 hr.Information regarding the mechanism of action of boric acid in mediating its antibacterial or antifungal actions is limited. Boric acid inhibits biofilm formation and hyphal transformation of _Candida albicans_, which are critical virulence factors [A32457]. In addition, arrest of fungal growth was observed with the treatment of boric acid [A32457].Both oil base and water base fracturing fluids are being used in the fracturing industry. Water base, which includes alcohol-water mixtures and low strength acids, make up the majority of treating fluids. The common chemicals added to these fluids are polymers for viscosity development, crosslinkers for viscosity enhancement, pH control chemicals, gel breakers for polymer degradation following the treatment, surfactants, clay stabilizers, alcohol, bactericides, fluid loss additives and friction reducer.Hydraulic fracturing uses a specially blended liquid which is pumped into a well under extreme pressure causing cracks in rock formations underground. These cracks in the rock then allow oil and natural gas to flow, increasing resource production. ... Chemical Name: Boric acid; Chemical Purpose: Maintains fluid viscosity as temperature increases; Product Function: Crosslinker.For boric acid (USEPA/OPP Pesticide Code: 011001) ACTIVE products with label matches. /SRP: Registered for use in the U.S. but approved pesticide uses may change periodically and so federal, state and local authorities must be consulted for currently approved uses.For weatherproofing wood and fireproofing fabrics; as a preservative; manufacture of cements, crockery, porcelain, enamels, glass, borates, leather, carpets, hats, soaps, artificial gems; in nickeling baths; cosmetics; printing and dyeing, painting; photography; for impregnating wicks; electric condensers; hardening steel. Also used as insecticide for cockroaches and black carpet beetles.Boric acid is used in the manufacture of paper and paperboard products used in food packaging for use in adhesives, sizes, and coatings.Manufacturing synthetic of metal borates, boron halides, boron phosphate, fluoborates, borate carbide, boron nitride esters, and alloys such as ferroboron.Added to gypsum slurry during production to increase the strength of the board, reduce board weight, provide better adhesion of the paper backing to the board, reduce curing time, prevent wrinkle formation on the board surface, and create a hard gypsum edge that withstands nailing and handling during construction. ... enhances sag resistance under humid conditions.Boric acid is also employed... as a... contact lens solution... and food preservative.Sodium borate and boric acid are also widely used in numerous cosmetic products, including makeup, skin and hair care preparations, deodorants, moisturizing creams, breath fresheners, and shaving creams, with concentrations up to 5%. /Sodium borate and Boric acid/The principal use of boric acid and borax in the USA is in the manufacture of glass products.Boric acid is manufactured industrially from borate minerals and brines. Alkali and alkaline-earth metal borates, such as borax, kernite, colemanite, ascharite, ulexite, or hydroboracite, react with strong mineral acids to form boric acid. In the United States boric acid is made primarily from sodium borate minerals, whereas in Europe it is made from colemanite imported from Turkey.(1) By adding hydrochloric or sulfuric acid to a solution of borax and crystallizing. (2) From weak borax brines, by extraction with a kerosine solution of chelating agent such as 2-ethyl-1,3-hexanediol, or other polyols. Borates are stripped from the chelate by sulfuric acid.Boric acid is produced mainly from sodium- or calcium-containing borate ores. The mined ore is crushed and ground before being reacted with sulfuric acid in the presence of a hot aqueous recycled liquor containing some boric acid. The resultant slurry contains insoluble gangue and either calcium or sodium sulfate by-product. After separation of unwanted insoluble gangue, recovery of the boric acid product is similar to that for borax.Crushed kernite ore is reacted with sulfuric acid in recycled weak liquor (contains low concentration of borates) at 100 °C. Coarse gangue is separated by rake classifiers and fine particles are settled in a thickener. The boric acid strong liquor (high borate concentration) is nearly saturated with sodium sulfate. Complete solubility of sodium sulfate is maintained throughout the process by careful control of pH and temperature. The strong liquor is filtered at 98 °C and boric acid crystallized in two stages using continuous evaporative crystallizers. The temperature is dropped to 70 °C in the first stage and to 35 °C in the second. Crystals are filtered and washed with progressively weaker liquor in a countercurrent fashion. The final product is dried in rotary driers and screened for packaging.The principal impurities in technical grade boric acid are the by-product sulfate (0.1%) and various minor metallic impurities present in the borate ore /technical grade/Textile-grade glass fibers, 35%; borosilicate glasses, 20%; fire retardants, 15%; enamels, fruits and glazes, 7%; metallurgy, 5%; adhesives, 3%; miscellaneous, 15% (1984).Boron oxide & boric acid combined: 20% is used in textile glass fibers; 19% as a flux in enamels, frits, & glazes; 9% in glasses; 1% as a herbicide; 51% in misc applications, including use as a catalyst in oxidation of hydrocarbons, as a conditioning agent, & in manufacture of other boron compounds (1969).Although no adverse effects have been reported from inhaling boric acid dust, it is absorbed through mucous membranes. Ingestion of 5 grams or more may irritate gastrointestinal tract and affect central nervous system. Contact with dust or aqueous solutions may irritate eyes; no chronic effects have been recognized, but continued contact should be avoided. Dust and solutions are absorbed through burns and open wounds but not through unbroken skin. (USCG, 1999)Literature sources indicate that this compound is nonflammable. (NTP, 1992)Irritant to skin in dry form.First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments, oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop. SKIN: IMMEDIATELY flood affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly with soap and water. If symptoms such as redness or irritation develop, IMMEDIATELY call a physician and be prepared to transport the victim to a hospital for treatment. INHALATION: IMMEDIATELY leave the contaminated area; take deep breaths of fresh air. If symptoms (such as wheezing, coughing, shortness of breath, or burning in the mouth, throat, or chest) develop, call a physician and be prepared to transport the victim to a hospital. Provide proper respiratory protection to rescuers entering an unknown atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not available, use a level of protection greater than or equal to that advised under Protective Clothing. INGESTION: DO NOT INDUCE VOMITING. If the victim is conscious and not convulsing, give 1 or 2 glasses of water to dilute the chemical and IMMEDIATELY call a hospital or poison control center. Be prepared to transport the victim to a hospital if advised by a physician. If the victim is convulsing or unconscious, do not give anything by mouth, ensure that the victim's airway is open and lay the victim on his/her side with the head lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY transport the victim to a hospital. (NTP, 1992)Personal protection: particulate filter respirator adapted to the airborne concentration of the substance. Sweep spilled substance into covered containers. If appropriate, moisten first to prevent dusting. Wash away remainder with plenty of water.The most favorable course of action is to use an alternative chemical product with less inherent propensity for occupational exposure or environmental contamination. Recycle any unused portion of the material for its approved use or return it to the manufacturer or supplier. Ultimate disposal of the chemical must consider: the material's impact on air quality; potential migration in soil or water; effects on animal, aquatic, and plant life; and conformance with environmental and public health regulations.The scientific literature for the use of contact lenses by industrial workers is inconsistent. The benefits or detrimental effects of wearing contact lenses depend not only upon the substance, but also on factors including the form of the substance, characteristics and duration of the exposure, the uses of other eye protection equipment, and the hygiene of the lenses. However, there may be individual substances whose irritating or corrosive properties are such that the wearing of contact lenses would be harmful to the eye. In those specific cases, contact lenses should not be worn. In any event, the usual eye protection equipment should be worn even when contact lenses are in place.Avoid depositing product onto exposed food and feed processing, preparation and serving surfaces, or introducing material into air. Do not apply when food processing facility is in operation. Any product visible after application must be brushed into cracks and crevices, or removed. Place product in areas that are inaccessible to children and pets.If you spill this chemical, you should dampen the solid spill material with water, then transfer the dampened material to a suitable container. Use absorbent paper dampened with water to pick up any remaining material. Seal your contaminated clothing and the absorbent paper in a vapor-tight plastic bag for eventual disposal. Wash all contaminated surfaces with a strong soap and water solution. Do not reenter the contaminated area until the Safety Officer (or other responsible person) has verified that the area has been properly cleaned. STORAGE PRECAUTIONS: You should store this material under ambient temperatures. (NTP, 1992)An exemption from the requirement of a tolerance is established for residues of the pesticidal chemical boric acid and its salts, borax (sodium borate decahydrate), disodium octaborate tetrahydrate, boric oxide (boric anhydride), sodium borate and sodium metaborate, in or on raw agricultural commodities when used as an active ingredient in insecticides, herbicides, or fungicides preharvest or postharvest in accordance with good agricultural practices.Residues of boric acid are exempted from the requirement of a tolerance when used in accordance with good agricultural practice as inert (or occasionally active) ingredients in pesticide formulations applied to growing crops only. Use: sequestrant. Limit: none.Chemical goggles; chemical resistant gloves and clothing.BORIC ACID is a very weak acid. Incompatible with alkali carbonates and hydroxides. During an attempt to make triacetyl borate, a mixture of boric acid and acetic anhydride exploded when heated to 58-60°C [Chem. Eng. News 51:(34) 1973]. Reacts violently with the strong reducing agent potassium metal.During an attempt to make triacetyl borate, a mixture of boric acid and acetic anhydride exploded when heated to 58-60 °C.Residues of boric acid are exempted from the requirement of a tolerance when used in accordance with good agricultural practice as inert (or occasionally active) ingredients in pesticide formulations applied to growing crops only. Use: sequestrant. Limit: none.An exemption from the requirement of a tolerance is established for residues of the pesticidal chemical boric acid and its salts, borax (sodium borate decahydrate), disodium octaborate tetrahydrate, boric oxide (boric anhydride), sodium borate and sodium metaborate, in or on raw agricultural commodities when used as an active ingredient in insecticides, herbicides, or fungicides preharvest or postharvest in accordance with good agricultural practices.Based on the reviews of the generic data for the active ingredients of boric acid and its sodium salts, the Agency has sufficient information on the health effects of boric acid and its sodium salts and their potential for causing adverse effects in fish and wildlife and the environment. Therefore, the Agency concludes that products containing boric acid and its sodium salts for all uses are eligible for reregistration. The Agency has determined that boric acid and its sodium salts, labeled and used as specified in the RED document, will not pose unreasonable risks or adverse effects to humans or the environment.As the federal pesticide law FIFRA directs, EPA is conducting a comprehensive review of older pesticides to consider their health and environmental effects and make decisions about their continued use. Under this pesticide reregistration program, EPA examines newer health and safety data for pesticide active ingredients initially registered before November 1, 1984, and determines whether the use of the pesticide does not pose unreasonable risk in accordance to newer saftey standards, such as those described in the Food Quality Protection Act of 1996. Borax is found on List A, which contains most food use pesticides and consists of the 194 chemical cases (or 350 individual active ingredients) for which EPA issued registration standards prior to FIFRA '88. Case No: 0024; Pesticide type: insecticide, fungicide herbicide; Registration Standard Date: 11/01/85; Case Status: RED Approved 9/93; OPP has made a decision that some/all uses of the pesticide are eligible for reregistration, as reflected in a Reregistration Eligibility Decision (RED) document .; Active ingredient (AI): boric acid; Data Call-in (DCI) Date(s): 2/16/94; AI Status: OPP has completed a Reregistration Eligibility Decision (RED) for the case/AI.Drug products containing certain active ingredients offered over-the-counter (OTC) for certain uses. A number of active ingredients have been present in OTC drug products for various uses, as described below. However, based on evidence currently available, there are inadequate data to establish general recognition of the safety and effectiveness of these ingredients for the specified uses: boric acid is included in topical acne drug products; dandruff/seborrheic dermatitis/psoriasis drug products; skin protectant drug products; astringent drug products; fever blister and cold sore treatment drug products; insect bite and sting drug products; poison ivy, poison oak, poison sumac drug products; ophthalmic anti-infective drug products; diaper rash drug products; and antiseptic drug products.The medical literature reporting 109 cases of acute toxicity caused by boric acid was reviewed in 1953... . In this series 35% were children less than 1 year of age; their mortality rate was 70%. The mortality rate of the entire series was 55%. Of the 80 cases for which information is available, 73% had GI disturbances, 67% had CNS effects, and 76% had cutaneous lesions.Genetic effects of boric acid and borax (2.5, 5 and 10 microm) on cultures with and without TiO(2) addition. No significant increase in /sister-chromatid exchanges/ (SCE) and micronuclei frequencies were observed at all concentrations of boron compounds. However, TiO(2)-induced SCE and micronuclei could be reduced significantly by the presence of boric acid and borax. In conclusion, this study indicated for the first time that boric acid and borax led to an increased resistance of DNA to damage induced by TiO(2).Previous results have shown that exposure of pregnant rats on GD10 to either hyperthermia (42C) or boric acid (BA) specifically targets segmentation patterns. Exposure to hyperthermia increased the prevalence of fused and/or reduced numbers of vertebrae and ribs, primarily in the thoracic area. BA (500-1000 mg/kg, single oral dose) resulted in a significant increase in segmentation defects similar to those seen after hyperthermia, with a greater incidence in lumbar defects. In this study, we focused on the interaction of these two agents and their effects on axial skeletal development. Pregnant rats were treated on GD10 as follows: Anesthesia with Nembutal (30 mg/kg), followed by oral dosing with either water or BA (500 mg/kg) and immersion in a water bath at 37C (30 min) or 42C (rectal temp maintained at 42C for 5 min). After delivery, pups were evaluated on postnatal day (PND) 1 and 3 for number, sex, and weight. No differences were seen in litter size, pup survival, or pup weight in any of the groups. On PND3, pups were examined and processed for skeletal staining with alizarin red and alcian blue. Preliminary data indicate an increase in skeletal alterations with BA+37C (47%), water+42C (75%), or BA+42C (67%), as compared to water+37C controls (0%). Alterations included defects in ribs and vertebrae and a decrease in the number of presacral vertebrae. Because the incidence of segmentation defects in the water+42C group was high, any interaction between BA and hyperthermia might have been obscured.Acute oral LD50 is 2660 mg/kg in rat [MSDS]. Individuals are likely to be exposed to boric acid from industrial manufacturing or processing. Local tissue injury from boric acid exposure is likely due to caustic effects. Systemic effects from boric acid poisoning usually occur from multiple exposures over a period of days and involve gastrointestinal, dermal, CNS, and renal manifestations. Gastrointestinal toxicity include persistent nausea, vomiting, diarrhea, epigastric pain, hematemesis, and blue-green discoloration of the feces and vomit [L2140]. Following the onset of GI symptoms, a characteristic intense generalized erythroderma follows [L2140]. Management of mild to moderate toxicity should be supportive. In case of severe toxicity, dialysis may be required in addition to supportive treatment.The diagnoses of boric acid poisoning can be confirmed with the measurement of blood or serum boric acid levels (nL=1.4 nmol/mL), but this test is not routinely available. Treatment of boric acid toxicity is mainly supportive. Activated charcoal is not recommended because of its relatively poor adsorptive capacity for boric acid. In cases of massive oral overdose or renal failure, hemodialysis, or perhaps exchange transfusion in infants, may be helpful in shortening the half-life of boric acid.In acute poisonings, if a large amount has been ingested and the patient is seen within one hour of exposure, gastrointestinal decontamination should be considered ... .It is important to keep in mind that vomiting and diarrhea are common, and severe poisoning may be associated with seizures. Therefore induction of emesis by syrup of ipecac is probably contraindicated in these exposures. Catharsis is not indicated if diarrhea is present.If ingestion of borate has been massive (several grams), or has extended over several days, administer intravenous glucose and electrolyte solutions to sustain urinary excretion of borate. Monitor fluid balance and serum electrolytes (including bicarbonate capacity) regularly. Monitor cardiac status by ECG. Test the urine for proteins and cells to detect renal injury, and monitor serum concentration of borate. Metabolic acidosis may be treated with sodium bicarbonate. If shock develops, it may be necessary to infuse plasma or whole blood. Administer oxygen continuously. If oliguria (less than 25 to 30 mL urine per hour) occurs, intravenous fluids must be slowed or stopped to avoid overloading the circulation. Such patients should be referred to a center capable of providing intensive care for critically ill patients.If renal failure occurs, hemodialysis may be necessary to maintain fluid balance and normal extracellular fluid composition. Hemodialysis has had limited success in enhancing clearance of borates. Peritoneal dialysis has been performed in borate poisoning and is felt to be as effective as, and safer than, exchange transfusion in removing borate. No large study has been done, but it is still used somewhat less frequently than hemodialysis. Immediate first aid: Ensure that adequate decontamination has been carried out. If patient is not breathing, start artificial respiration, preferably with a demand-valve resuscitator, bag-valve-mask device, or pocket mask, as trained. Perform CPR as necessary. Immediately flush contaminated eyes with gently flowing water. Do not induce vomiting. If vomiting occurs, lean patient forward or place on left side (head-down position, if possible) to maintain an open airway and prevent aspiration. Keep patient quiet and maintain normal body temperature. Obtain medical attention.Basic treatment: Establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Suction if necessary. Aggressive airway management may be necessary. Watch for signs of respiratory insufficiency and assist ventilations if necessary. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for pulmonary edema and treat if necessary ... . Monitor for shock and treat if necessary ... . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with 0.9% saline (NS) during transport ... . Do not use emetics. For ingestion, rinse mouth and administer 5 ml/kg up to 200 ml of water for dilution if the patient can swallow, has a strong gag reflex, and does not drool. Administer activated charcoal ... . Cover skin burns with dry sterile dressing after decontamination.Advanced treatment: Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious, has severe pulmonary edema, or is in severe respiratory distress. Early intubation at the first sign of upper airway obstruction may be necessary. Positive-pressure ventilation techniques with a bag valve mask device may be beneficial. Consider drug therapy for pulmonary edema ... . Monitor cardiac rhythm and treat arrhythmias if necessary ... . Start IV administration of D5W /SRP: "To keep open", minimal flow rate/. Use 0.9% saline (NS) or lactated Ringer's (LR) if signs of hypovolemia are present. For hypotension with signs of hypovolemia, administer fluid cautiously. Consider vasopressors if patient is hypotensive with a normal fluid volume. Watch for signs of fluid overload ... . Use proparacaine hydrochloride to assist eye irrigation.Emergency and supportive measures: Maintain an open airway and assist ventilation if necessary. Treat coma, seizures, hypotension, and renal failure if they occur.Decontamination: Activated charcoal is not very effective. consider gastric lavage for very large ingestions.Enhanced elimination: Hemodialysis is effective and is indicated after massive ingestions and for supportive care of renal failure. Peritoneal dialysis has not proved effective in enhancing elimination in infants.