Dakin's solution is a dilute solution of

sodium hypochlorite Sodium hypochlorite is an alkaline inorganic chemical compound with the formula (also written as NaClO). It is commonly known in a dilute aqueous solution as bleach or chlorine bleach. It is the sodium salt of hypochlorous acid, consisting of ...

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

antiseptic An antiseptic ( and ) is an antimicrobial substance or compound that is applied to living tissue to reduce the possibility of sepsis, infection, or putrefaction. Antiseptics are generally distinguished from ''antibiotics'' by the latter's abil ...

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

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

.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 Petroleum jelly, petrolatum (), white petrolatum, soft paraffin, or multi-hydrocarbon, CAS number 8009-03-8, is a semi-solid mixture of hydrocarbons (with carbon numbers mainly higher than 25), originally promoted as a topical ointment for i ...

) 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. * British national identity, the characteristics of British people and culture ...

chemist

Henry Drysdale Dakin Henry Drysdale Dakin Fellow of the Royal Society, FRS (12 March 188010 February 1952) was an England, 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 ...

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

World War I World War I or the First World War (28 July 1914 – 11 November 1918), also known as the Great War, was a World war, global conflict between two coalitions: the Allies of World War I, Allies (or Entente) and the Central Powers. Fighting to ...

, while he was stationed at a field hospital in

Compiègne Compiègne (; ) is a Communes of France, commune in the Oise Departments of France, department of northern France. It is located on the river Oise (river), Oise, and its inhabitants are called ''Compiégnois'' (). Administration Compiègne is t ...

. He worked there in collaboration with French physician Alexis Carrel, 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's potassium hypochlorite solution, produced as ''Eau de Javel'' since the late 18th century. Around that time, he also discovered the

disinfectant A disinfectant is a chemical substance or compound used to inactivate or destroy microorganisms on inert surfaces. Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective than ...

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,

slaughterhouse In livestock agriculture and the meat industry, a slaughterhouse, also called an abattoir (), is a facility where livestock animals are slaughtered to provide food. Slaughterhouses supply meat, which then becomes the responsibility of a mea ...

s, and all industries dealing with animal products.Labarraque, Antoine-Germain
'' Nouvelle biographie générale'', 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

chloramine Monochloramine, often called chloramine, is the chemical compound with the formula NH2Cl. Together with dichloramine (NHCl2) and nitrogen trichloride (NCl3), it is one of the three chloramines of ammonia. It is a colorless liquid at its melting ...

s 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 is an inorganic compound with the chemical formula , also written as HClO, HOCl, or ClHO. Its structure is . It is an acid that forms when chlorine dissolves in water, and itself partially dissociates, forming a hypochlorite an ...

. 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 (1 September 1939 – 2 September 1945) was a World war, global conflict between two coalitions: the Allies of World War II, Allies and the Axis powers. World War II by country, Nearly all of the wo ...

, presumably due to his active involvement in

eugenics Eugenics is a set of largely discredited beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter the frequency of various human phenotypes by inhibiting the fer ...

movements and the advocacy of elimination of "inferior" humans. Since

penicillin Penicillins (P, PCN or PEN) are a group of beta-lactam antibiotic, β-lactam antibiotics originally obtained from ''Penicillium'' Mold (fungus), moulds, principally ''Penicillium chrysogenum, P. chrysogenum'' and ''Penicillium rubens, P. ru ...

became established as an

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

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 2023) 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 2023-12-04.Skin and Wound Product Information Sheet - Dakin's Solution
. British Columbia Provincial Nursing Skin & Wound Committee. Accessed on 2024-03-24.

Formulation

Dakin's original solution contained

(0.4% to 0.5%), prepared by treating

calcium hypochlorite Calcium hypochlorite is an inorganic compound with chemical formula , also written as . It is a white solid, although commercial samples appear yellow. It strongly smells of chlorine, owing to its slow decomposition in moist air. This compound is ...

with

sodium carbonate Sodium carbonate (also known as washing soda, soda ash, sal soda, and soda crystals) is the inorganic compound with the formula and its various hydrates. All forms are white, odourless, water-soluble salts that yield alkaline solutions in water ...

("washing soda"). The solution left after removal of the insoluble

calcium carbonate Calcium carbonate is a chemical compound with the chemical formula . It is a common substance found in Rock (geology), rocks as the minerals calcite and aragonite, most notably in chalk and limestone, eggshells, gastropod shells, shellfish skel ...

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 orthoborate, trihydroxidoboron or boracic acid. It is usually encountered as colorless crystals or a white ...

(4%) was then added as a

buffering agent A buffer solution is a solution where the pH does not change significantly on dilution or if an acid or base is added at constant temperature. Its pH changes very little when a small amount of strong acid or base is added to it. Buffer solution ...

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

alkalinity Alkalinity (from ) is the capacity of water to resist Freshwater acidification, acidification. It should not be confused with base (chemistry), basicity, which is an absolute measurement on the pH scale. Alkalinity is the strength of a buffer s ...

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 Sodium bicarbonate ( IUPAC name: sodium hydrogencarbonate), commonly known as baking soda or bicarbonate of soda (or simply “bicarb” especially in the UK) is a chemical compound with the formula NaHCO3. It is a salt composed of a sodium cat ...

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). Retrieved 14 June 2018 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.

Centers 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 (HHS), and is headquartered in Atlanta, ...

(CDC) as a household disinfectant. 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 Currently, various concentrations are sold for wound cleansing including Anasept (0.057%), 1/4 strength Dakin's (0.125%), and Di-Dak-Sol or Dakin's Wound Cleanser (0.0125%) which is 1/40 strength.

References

{{reflist Antiseptics

Use

History

Formulation

See also

References