No, she wasn’t, but it was just as bad.
Early this month, 28-year-old Ekaterina Fedyaeva died three weeks after what was supposed to have been a routine laparoscopic operation to treat ovarian cysts suspected of causing infertility. I want to discuss two issues about the incident.
1. Sloppy reporting. Initial reports in several media outlets stated her death had been due to the intravenous administration of formalin instead of saline.
WSVN 7 News: “Russian woman dies after doctors put formaldehyde instead of saline into IV drip.”
Newsweek: “Woman killed with formaldehyde drip in-hospital blunder.”
CBS News: “Woman died after hospital put formaldehyde instead of saline in IV, reports say.”
Syracuse.com: “Woman dies after accidentally getting formaldehyde drip in surgery in Russia.”
The Washington Post: “Her surgery was supposed to be routine. Instead, this Russian woman was ‘embalmed alive.’”
The Scottish Sun: “Russian woman, 27, dies in agony after she was ‘embalmed alive’ instead of being put on saline.”
2. Here’s what really happened. Many physicians on Twitter questioned the supposed IV administration of formalin because we know it is supplied in nonsterile jugs or bottles not compatible with IV tubing and therefore nearly impossible to confuse with IV sterile saline. It has a distinctive odor often described as irritating. Saline has no odor at all.
Formalin contains formaldehyde and is used to embalm dead bodies and to preserve surgical specimens for histologic examination. Specimen jars filled with the liquid are located in each operating room. OSHA and EPA regulations call for formalin storage bottles to be clearly marked as formalin and labeled as a chemical hazard.
If any of the initial stories had simply included an interview with a surgeon, the likelihood of a patient being given intravenous formalin would have been rejected. The Washington Post account hinted at the true cause of the poisoning by stating, “The medical team tried to wash Fedyaeva’s abdominal cavity, according to Tass, but it was too late.”
The website Snopes found the original Russian article about the disaster and reported, as many of us had suspected, the formalin not given IV but rather was mistakenly used to irrigate the abdomen during the surgery. The cause of the error is not yet known.
After transfer to a Moscow medical center, Mrs. Fedyaeva died. Several staff at the hospital where the surgery took place were fired, and Russian authorities began a criminal investigation.
A literature search turned up two interesting case reports. After a meniscectomy in Poland, a 33-year-old man accidentally received an IV injection of 4% formaldehyde instead of an antibiotic. The error was discovered when the excised meniscus was seen the vial which was thought to have contained the drug. He suffered no ill effects. The authors estimate that he had received only about 400 mg of formaldehyde and stated the lethal IV dose is 12 g.
A 1982 paper involved a 74-year-old woman who had been treated with radiation for cervical cancer three years before. She had hematuria and underwent cystoscopy with fulguration of bleeders and a bladder biopsy. One week later, she presented with massive hematuria requiring 4 units of blood transfusion. Another cystoscopy showed diffuse bleeding.
Formalin, widely used in the treatment of radiation cystitis and proctitis, was instilled in the bladder. An attempt to recover the solution after 15 minutes was unsuccessful. A cystogram revealed a leak from the bladder—probably from the previous biopsy site. An exploratory laparotomy was immediately done. The peritoneal cavity was irrigated and drains were placed.
Severe metabolic acidosis, hyperglycemia, fluid sequestration, hypocalcemia, and multiple organ failure ensued. She died one month later.
The Russian patient probably suffered similar complications. It must have been a horrible death.
This tragedy should never have occurred. The chief of surgery and operating room supervisor at every hospital in the word should review this case and say why it could not happen there.
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 17,000 followers on Twitter.