The Tissue Distribution of Fluoride in a Fatal Case of Self-Poisoning

Abstract

The purpose of this paper is to report a case of fluoride poisoning along with a discussion of poisoning characteristics, analytical procedures, and a review of previous reports of fatal intoxications with analytical data. A case of suicidal ingestion of 40 mL of a rust removal agent containing hydrofluoric acid and ammonium fluoride by a 33-year-old white male is presented. He had an organic personality disorder with residual schizophrenia and previous suicide attempts with therapeutic drugs and cleaning products. At admission, he presented with a Glasgow coma score of 3, third degree atrioventricular block, and asystole. Resuscitation efforts were performed during which the patient suffered two episodes of ventricular fibrillation followed by asystole. In spite of advanced resuscitation efforts and the administration of calcium chloride, he died 2.5 h after the ingestion. Analytical data in the hospital showed calcium levels of 3.1 mg/dL and metabolic acidosis. Internal findings were erosive gastritis, brain edema, and pulmonary and hepatic congestion. Quantitation of fluoride was performed using an ion-selective electrode for the anion. Disposition of fluoride in the different tissues was as follows: peripheral blood, 19.4 mg/L; urine, 670 mg/L; vitreous humor, 2.5 mg/L; liver, 40.0 mg/kg; kidney, 60.0 mg/kg; lung, 17.5 mg/kg; brain, 2.5 mg/kg; spleen, 30.0 mg/kg; bone, 0.5 mg/ kg; and gastric content, 1120 mg/L (67 mg total). Validation of the analytical method was performed using different spiked tissues, in a range of concentrations from 2.4 to 475 mg/L or mg/kg, and submitting them to dilution (1:25) to avoid the matrix effect and to bring these concentrations to the range of the aqueous calibration curve (0.19-19 mg/L). Limits of detection and quantitation were 0.02 and 0.1 mg/L, respectively. The linearity of the method, for all studies tissues, was excellent, with r(2) values of 0.999. Accuracy and precision were within 10.5% and 5.7%, respectively. Fluoride analyses using the ion selective electrode are simple, sensitive, and rapid. This report provides an extensive tissue distribution study of fluoride after a well documented case of acute poisoning. Based on the autopsy findings, patient history, toxicology results, and previously reported data the forensic pathologists ruled that the cause of death was due to a fluoride poisoning, and the manner of death was listed as suicide.

Fatal cases of acute suicidal sodium and accidental zinc fluorosilicate poisoning. Review of acute intoxications due to fluoride compounds

“…Values reported earlier were generally higher (see Table 3), probably due to using analytical procedures that were sometimes insufficiently checked. As fluoride has a very short half-life in the body and the major route for fluoride excretion is via the kidneys, human exposure is best measured in urine, where the concentration is expected to be highest, as in case 1 in this paper, and in cases of intoxicated individuals described by Martinez et al [16] and Poklis and Mackell [25]. Levels of fluoride in the urine of healthy individuals are related to the intake of fluoride.…”

“…Although ingestion of toxic amounts of fluoride is rare, care should be taken to avoid intoxication by fluoride containing agents, because there have occasionally been cases of accidental or intentional (suicide, homicide) poisonings by fluorides in various places (home, work, hospital) [1,2,[9][10][11]13,14,16,[25][26][27]30]. Industrial exposure to fluoride is generally the result of inhalation of dust produced during the processing of fluoride containing minerals [9,33], but, sometimes, exposures at the workplace are due to splashing with hydrofluoric acid [20,22,23] or skin contact with hydrofluoric acid or sodium fluorosilicates [24].…”

“…Although fluoride poisonings are not as frequent as 30-40 years ago [10][11][12][13][14], they are, nevertheless, still important in the field of toxicology [15][16][17]. Acute fluoride poisoning may result from ingestion, inhalation or bodily contact with concentrated fluoride compounds (acid splash) [18][19][20][21][22][23] or sodium hexafluorosilicate [24].…”

“…Acute fluoride poisoning may result from ingestion, inhalation or bodily contact with concentrated fluoride compounds (acid splash) [18][19][20][21][22][23] or sodium hexafluorosilicate [24]. Acute intoxication has involved sodium fluoride [3,5,17,[25][26][27], sodium fluoroacetate [9], ammonium bifluoride [5,16,18,28], sulfuryl fluoride [29], hydrofluoric acid [15,16,[18][19][20]22,23], and various fluorosilicates [10][11][12]14,30,31]. Some fluorosilicates, salts of fluorosilicic acid (e.g.…”

Effects of fluorosis on QT dispersion, heart rate variability and echocardiographic parameters in children

“…Fluoride produces deleterious effects on the skeleton, teeth, and soft tissues, but the mechanisms are not fully understood. Acute toxic level exposures lead to vomiting, cramps, diarrhea, and finally lethal ventricular fibrillation (16).…”