Dakin's solution is a dilute solution of

sodium hypochlorite Sodium hypochlorite (commonly known in a dilute solution as bleach) is an inorganic chemical compound with the formula NaOCl (or NaClO), comprising a sodium cation () and a hypochlorite anion (or ). It may also be viewed as the sodium s ...

(0.4% to 0.5%) and other stabilizing ingredients, traditionally used as an

antiseptic An antiseptic (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") is an antimicrobial substance or compound that is applied to living tissue/skin to reduce the possibility of infection, sepsis, or putre ...

, e.g. to cleanse wounds in order to prevent

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

.Jeffrey M. Levine (2013): "Dakin’s Solution: Past, Present, and Future". ''Advances in Skin & Wound Care: The Journal for Prevention and Healing'', volume 26, issue 9, pp. 410–414. The preparation was for a time called also Carrel–Dakin solution or Carrel–Dakin fluid.

Use

Carrel and Dakin used a variety of apparatuses to infuse the solution continuously over the wounds. In modern typical usage, the solution is applied to the wound once daily for lightly to moderately exudative wounds, and twice daily for heavily exudative wounds or highly contaminated wounds.Century Pharmaceuticals, Inc.:
Dakin's solution FAQ
. Accessed 2018-06-14. The healthy skin surrounding the wound should preferably be protected with a moisture barrier ointment (e.g., petroleum jelly) or skin sealant as needed to prevent irritation.Dakin's solution, Non-
. WebMD online page. Accessed on 2018-06-14.

History

The solution takes the name from

British British may refer to: Peoples, culture, and language * British people, nationals or natives of the United Kingdom, British Overseas Territories, and Crown Dependencies. ** Britishness, the British identity and common culture * British English, ...

chemist

Henry Drysdale Dakin Henry Drysdale Dakin FRS (12 March 188010 February 1952) was an English chemist. He was born in London as the youngest of 8 children to a family of steel merchants from Leeds. As a school boy, he conducted water analysis with the Leeds City Ana ...

(1880–1952) who developed it in 1916, during

World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...

, while he was stationed at a field hospital in

Compiègne Compiègne (; pcd, Compiène) is a commune in the Oise department in northern France. It is located on the river Oise. Its inhabitants are called ''Compiégnois''. Administration Compiègne is the seat of two cantons: * Compiègne-1 (with 19 ...

. He worked there in collaboration with French physician

Alexis Carrel Alexis Carrel (; 28 June 1873 – 5 November 1944) was a French surgeon and biologist who was awarded the Nobel Prize in Physiology or Medicine in 1912 for pioneering vascular suturing techniques. He invented the first perfusion pump with Charl ...

, and the particular use they made of the solution is known as the Carrel–Dakin method for wound treatment. Sodium hypochlorite solution had been developed as a bleaching agent around 1820 by the French chemist Antoine Labarraque, as a cheaper substitute for

Claude Berthollet Claude Louis Berthollet (, 9 December 1748 – 6 November 1822) was a Savoyard-French chemist who became vice president of the French Senate in 1804. He is known for his scientific contributions to theory of chemical equilibria via the mecha ...

's potassium hypochlorite solution, produced as ''Eau de Javel'' since the late 18th century. Around that time, he also discovered the disinfectant properties of his ''Eau de Labarraque'', which was quickly adopted for that purpose.Scott, James, transl. (1828).
On the disinfecting properties of Labarraque's preparations of chlorine
' Published by S. Highley. His work greatly improved medical practice, public health, and the sanitary conditions in hospitals, slaughterhouses, and all industries dealing with animal products.Labarraque, Antoine-Germain
''

Nouvelle biographie générale The ''Nouvelle Biographie Générale''Its full title was ''Nouvelle Biographie Générale, depuis les temps les plus reculés jusqu'a nos jours, avec les renseignements bibliographiques et l'indication des sources a consulter'' ("New General Biog ...

'', volume 28 (1859), columns 323–324. However, those products were too concentrated and alkaline for use on wounds, as they strongly irritated healthy tissues. Almost a century later Carrel and Dakin observed that few doctors at the time practiced

asepsis Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...

, and moreover there were no studies of the effectiveness of various antiseptics for wounds. They set out to look for a substance that did not irritate skin, yet had sufficient bactericidal power. Dakin tested more than 200 substances, measuring their action on tissues and bacteria. He found chloramines to be the best, for being stable, non-toxic, and not very irritating, yet powerful bactericides, presumably due to their release of

hypochlorous acid Hypochlorous acid (HClO, HOCl, or ClHO) is a weak acid that forms when chlorine dissolves in water, and itself partially dissociates, forming hypochlorite, ClO−. HClO and ClO− are oxidizers, and the primary disinfection agents of chlorine sol ...

. However, the difficulty of procuring them led him to choose "hypochlorite of soda" as a practical alternative.Henry D. Dakin (1915): "On the use of certain antiseptic substances in the treatment of infected wounds". ''British Medical Journal'', volume 2, issue 2852, pp. 318–310.H. D. Dakin and E. K. Kunham (1918). ''A Handbook of Antiseptics''. Published by Macmillan, New York.H. D. Dakin (1915): ''Comptes rendues de la Academie des Sciences'', CLXI, p. 150. Cited by Marcel Dufresne, ''Presse médicale' (1916) Between the two World Wars, the preparation was often called "Carrel–Dakin solution," even though Dakin did the bulk of the research work that led to its formulation. The name of Carrel was dropped after

World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposing ...

, presumably due to his active involvement in

eugenics Eugenics ( ; ) is a fringe set of beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups judged to be inferior o ...

movements and the advocacy of elimination of "inferior" humans. Since penicillin became established as an antibiotic in 1943, use of Dakin's solution and other topical antiseptics for wound treatment has declined, and their use is frowned upon in modern medical care.N. Bergstrom, M. A. Bennett, C. E. Carlson, et al. (1994): "Treatment of Pressure Ulcers". ''Clinical Practice Guideline'', number 15. Publication 95-0652 of the Agency for Health Care Policy and Research (AHCPR), Rockville, MD. However, the solution continues to be used (as of 2013) due to its broad activity against aerobic and anaerobic organisms, including fungi and antibiotic-resistant organisms, its very low cost, and its wide availability.D. Doughty (1994): "A rational approach to the use of topical antiseptics". ''Journal of Wound Ostomy & Continence Nursing'', volume 21, pp. 224–231. B. Altunoluk, S. Resim, E. Efe, et al. (2012):
Fournier's gangrene: conventional dressings versus dressings with Dakin's solution
''ISRN Urology'', , , P. Cornwell, M. Arnold-Long, S. B. Barss, M. F. Varnado (2010): "The use of Dakin's solution in chronic wounds". ''Journal of Wound Ostomy & Continence Nursing'', volume 37, pp. 94–104. In emergency situations, it can be produced on the field from liquid bleach and sodium bicarbonate.How to Make Dakin's Solution
. Center for Health Information, Department of Inpatient Nursing, The Ohio State University Medical Center. Accessed on 2018-06-14.

Formulation

Dakin's original solution contained

(0.4% to 0.5%), prepared by treating calcium hypochlorite with sodium carbonate ("washing soda"). The solution left after removal of the insoluble calcium carbonate still contained some soda.

Boric acid Boric acid, more specifically orthoboric acid, is a compound of boron, oxygen, and hydrogen with formula . It may also be called hydrogen borate or boracic acid. It is usually encountered as colorless crystals or a white powder, that dissolve ...

(4%) was then added as a

buffering agent A buffer solution (more precisely, pH buffer or hydrogen ion buffer) is an aqueous solution consisting of a mixture of a weak acid and its conjugate base, or vice versa. Its pH changes very little when a small amount of strong acid or base is ...

to maintain a pH of between 9 and 10. Dakin found that

alkalinity Alkalinity (from ar, القلوي, al-qaly, lit=ashes of the saltwort) is the capacity of water to resist acidification. It should not be confused with basicity, which is an absolute measurement on the pH scale. Alkalinity is the strength ...

outside this range was too irritating.Glenn E. Cullen and Roger S. Hubbard (1919):
Note on the stabilization of dilute sodium hypochlorite solutions (Dakin's solution)
. ''Journal of Biological Chemistry'', volume 37, pp. 511–517. The solution, while unstable, remains effective for at least a week, if made to the correct pH. Other formulations have been developed over time. In 1916, Marcel Daufresne substituted sodium bicarbonate for Dakin's boric acid as buffering agent.Marcel Daufresne (1916),
Mode de préparation de l'hypochlorite de soude chirurgical - Differénce entre la soulution de Dakin et celle de Labarraque
. ''Presse médicale'', volume xxiv, p. 474. This formulation is the basis of current commercial products.Century Pharmaceuticals, Inc. (2006):
Dakin’s Solution products
Material Safety Data Sheet (MSDS). Accessed on 2018-06-14 The concentration chosen by Dakin (0.5%) was the maximum highest concentration found tolerable to the skin. It is the concentration recommended by the U.S.

Center for Disease Control The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...

(CDC) as a household disinfectant.https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf In one study, bactericidal effects of sodium hypochlorite solution were observed at concentrations as low as 0.025%, without any tissue toxicity in vivo or in vitro. It recommended that concentration be adopted as a "modified Dakin's solution" for wound dressing.J. P. Heggers, J. A. Sazy, B. D. Stenberg, L. L. Strock, R. L. McCauley, D. N. Herndon, and M. C. Robson (1991): "Bactericidal and Wound-Healing Properties of Sodium Hypochlorite Solutions: The 1991 Lindberg Award". ''Journal of Burn Care & Rehabilitation'', volume 12, issue 5, pp. 420–424. https://academic.oup.com/jbcr/article-abstract/12/5/420/4786784

References

{{reflist Antiseptics

Use

History

Formulation

See also

References