Fatality due to acute fluoride poisoning in the workplace

Takase, Izumi; Kono, Koichi; Tamura, Akiyoshi; Nishio, Hisahide; Dote, Tomotaro; Suzuki, Koichi

doi:10.1016/j.legalmed.2004.04.003

Cited by 40 publications

(21 citation statements)

References 21 publications

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“…Takese et al described a patient with fatal dermal exposure from HF, whose post-arrest electrolytes demonstrated both hyperkalemia and hypocalcemia. The patient's pre-arrest course is not reported (34). One case report of HF attributed VF to hyperkalemia based on the demonstration of a wide complex tachycardia that preceded death, but in this case the only potassium level reported was normal (4).…”

Section: Discussionmentioning

confidence: 96%

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Recurrent life-threatening ventricular dysrhythmias associated with acute hydrofluoric acid ingestion: Observations in one case and implications for mechanism of toxicity

Vohra

Velez

Rivera

et al. 2008

Clinical Toxicology

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University of Texas, Southwestern Medical Center at Dallas, Dallas, Texas, USAIntroduction. Hydrofluoric acid (HF) is a weak inorganic acid used for etching and as rust remover. Systemic toxicity is manifested as ventricular dysrhythmias. The mechanisms for these dysrhythmias are not well elucidated. Case report. An 82-year-old woman ingested 8 ounces of 7% HF. Shortly after emergency department (ED) arrival, she became pulseless, developing recurrent ventricular dysrhythmias. She was defibrillated 17 times and received several doses of calcium, magnesium, and lidocaine. After three hours, she returned to sustained NSR. She was discharged home after four days. Discussion. The electrocardiographic findings in this patient demonstrate hypocalcemia, which has been implicated as the culprit in HF-induced arrhythmias. However, despite correction of the hypocalcemia, the ventricular arrhythmias persisted. The proposed mechanisms of systemic HF toxicity and the relevant literature are discussed. Conclusion. Ventricular dysrhythmias due to HF toxicity seem to be independent of either hypocalcemia or hyperkalemia. Systemic toxicity after ingestions may be delayed and precipitous.

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Section: Discussionmentioning

confidence: 96%

“…Severe and fatal poisonings by both NaF and HF have been associated with profound hypocalcemia in numerous published case reports (1,2,5-11, 15,16,22,34,38,39). In addition to direct binding and precipitation of free ionized calcium, potassium abnormalities have been described with sodium fluoride toxicity.…”

Section: Discussionmentioning

confidence: 99%

Recurrent life-threatening ventricular dysrhythmias associated with acute hydrofluoric acid ingestion: Observations in one case and implications for mechanism of toxicity

Vohra

Velez

Rivera

et al. 2008

Clinical Toxicology

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“…6 However, only a few case reports showing the use of calcium gluconate in HF inhalational exposures. 7 Further clinical studies are necessary.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Acute Respiratory Distress Syndrome from Hydrofluoric Acid Inhalation

Sun

Yang

et al. 2017

IJRRT

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Hydrofluoric acid (HF) is an industrial chemical widely used in many industries, including industries of the aluminum, steel, fertilizer, glass, ceramic, and brick. In a variety of settings, HF is a pollutant usually created in an industrial process. 1 Studies showed that concentrated HF contamination may cause a fatal outcome even if small areas of body surface are exposed. 2,3 The case reported here is acute respiratory distress syndrome (ARDS) due to accidental inhalation of HF. In cases of refractory hypoxemia, extracorporeal membrane oxygenation (ECMO) is becoming an acceptable rescue therapy. We believe severe hypoxemic respiratory failure as a result of ARDS caused by inhalation of HF in which venovenous-ECMO (VV-ECMO) was used successfully as a bridge to lung recovery has not been previous reported. the right internal jugular vein was cannulated with a 27F Avalon Elite cannula (Maquet Cardiohelp HLS device) within 2hours. Initial VV-ECMO ows were 3L/min with a sweep ow of 2.5L/min at 100% FiO2. Settings were subsequently titrated to clinical status. After VV-ECMO initiation, the patient was placed on pressure control ventilation with 15cm H₂O of PEEP and inspiratory pressure of 25cm H₂O. Four days after supportive therapy, the patient was weaned successfully from VV-ECMO support. Chest X-ray scan showed a resolving ARDS-type pattern (Figure 3). By hospital day 10, the patient was transferred to the ward, he continued to need ventilatory support and subsequently underwent tracheostomy placement. After 4weeks on the ventilator, ventilatory support was withdrawn considering he tolerated breathing via his tracheostomy for more than 24hours. On hospital day 37, he was discharged from the hospital with no infiltrates in the lungs (Figure 4). Keywords: hydrofluoric acid, inhalation, ARDS, ECMO DiscussionAfter inhalation of HF, the highly reactive fluoride ion forms complexes mainly with calcium which can result in severe hypocalcemia, leading to myocardial irritability or dysrhythmias. 4 Most published case reports showed that exposure to HF producing hypocalcemia and hypomagnesemia, usually accompanied by hyperkalemia. 5 The patient in this case report presented with hypocalcemia, but no hypomagnesemia or hypokalemia, which is unusual.Calcium gluconate was widely used in cutaneous HF exposure. 6 However, only a few case reports showing the use of calcium gluconate in HF inhalational exposures. 7 Further clinical studies are necessary.Acute lung injury resulting in noncardiogenic pulmonary edema after exposure to HF has not previous been reported. When HF was exposed to the upper airways of the rodent models, HF would enter into the systemic circulation rapidly. A very small quantity of HF gas exposure always causing serious problem. The research showed that HF delivered to the lower airways directly caused significant pulmonary hemorrhage and edema. 8 The development of syndromes have been consistent with studies done in human volunteers. 9After failure of conventional modes of ventilation in patient...

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“…In the fatal cases reported, doses ranged from 4 to 30 mgF/kg 41 , Signs and symptoms of acute fluoride poisoning include vomiting, diarrhea, ventricular fibrillation, bronchospasm, hemoptysis, dilated pupils, cramps, cardiac collapse, hypocalcemia, hypokalemia, impaired renal function, and other complications 42 . Adverse effects of fluoride at the level of water fluoridation, that is, low doses ingested over a long period, characterize chronic intoxication, which generates the most common condition in this category of toxicity, dental fluorosis, and, in more severe cases, bone pathologies, such as osteosclerosis.…”

Section: Harmsmentioning

confidence: 99%

Fluoretação da água de abastecimento público: abordagem bioética, legal e política

Garbín¹,

Santos²,

Garbín³

et al. 2017

Rev. Bioét.

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This article aims to analyze the bioethical aspects and legal and political issues of water fluoridation, creating a discussion based on established studies and new research, in order to contribute to an ethical and impartial perspective on the subject. A bibliographic review study was performed, based on a survey of specialized literature on "fluoridation", "bioethics" and "fluoride poisoning". Water fluoridation is an important public health measure for the prevention of dental caries, and its efficacy has been demonstrated in several studies. As it is mandatory under Brazilian law, bioethical dilemmas arise due to the absence of individual choice on whether to consume or not consume fluoridated water. There appears to be no solution to this moral dilemma, as even if the measure were free from any risk, its compulsory application would still violate the principle of autonomy. Keywords: Fluoridation. Bioethics. Fluoride poisoning. ResumoFluoretação da água de abastecimento público: abordagem bioética, legal e política Este artigo tem como objetivo analisar aspectos bioéticos e questões legais e políticas da fluoretação de águas de abastecimento público, criando discussões baseadas em estudos consagrados e em novas pesquisas, a fim de contribuir para abordagem imparcial do tema. Trata-se de revisão bibliográfica realizada após levantamento de literatura especializada sobre "fluoretação", "bioética" e "intoxicação por flúor". Foram selecionados estudos que possibilitaram discussão plural, relevantes para o debate do tema. A fluoretação das águas de abastecimento público é importante medida de saúde pública para prevenir a cárie dentária, tendo sua eficácia comprovada em vários estudos. Sua obrigatoriedade prevista por lei federal gera dilemas bioéticos, pois exclui a possibilidade de escolha individual de consumir ou não água fluoretada. Não parece haver saída para esse dilema moral, mesmo se a medida fosse livre de qualquer risco, pois ainda assim violaria o princípio da autonomia. Palavras-chave: Fluoretação. Bioética. Intoxicação por flúor. ResumenLa fluoración del agua de abastecimiento público: abordaje bioético, legal y político El objetivo de este artículo es analizar los aspectos bioéticos y asuntos legales y políticos de la fluoración del agua de abastecimiento público, al crear discusiones en base a estudios consagrados y a nuevas investigaciones, con el fin de contribuir con un enfoque imparcial del tema. Se trata de la revisión bibliográfica realizada después de estudiar la literatura especializada sobre la "fluoración", "bioética" e " intoxicación por flúor". Se seleccionaron los estudios que permitieron la discusión plural, lo cual fue relevante para el debate del tema. La fluoración de agua de abastecimiento público es una medida de salud pública importante para prevenir la caries dental y su efectividad se comprobó en varios estudios. Su obligatoriedad prevista por la Ley Federal genera dilemas bioéticos, ya que elimina la posibilidad de la elección individual de consumir o no el agua fluo...

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Fatality due to acute fluoride poisoning in the workplace

Cited by 40 publications

References 21 publications

Recurrent life-threatening ventricular dysrhythmias associated with acute hydrofluoric acid ingestion: Observations in one case and implications for mechanism of toxicity

Recurrent life-threatening ventricular dysrhythmias associated with acute hydrofluoric acid ingestion: Observations in one case and implications for mechanism of toxicity

Successful Treatment of Acute Respiratory Distress Syndrome from Hydrofluoric Acid Inhalation

Fluoretação da água de abastecimento público: abordagem bioética, legal e política

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