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

Figures & data

Table 1. Initial potassium and calcium levels in patients with life-threatening toxicity associated with exposure to fluoride compounds

Author	Exposure	Calcium mg/dL	K + mEq/L	Fluoride(serum)	ECG effect#	Dysrhythmia	Reference
Bjornhagan	HF dermal	0.67*	3.7	0.12 mmol/L	Normal	VF X 5	10
McIvor 1987	HF dermal	4.6 (nadir)	3.3	ND	Wide complex	VF Death	4
Tepperman	HF dermal	2.2 (nadir)	ND	3 mg/L	QT^c 500 msec	VF Death	8
Yolken	Na2S1F6	3.4	6.7	14 mg/L	QT^c 520, TW peaked	VF, VT X 8	22
Chan (1)	HF dermal	ND	ND	ND	Idioventricular	VF death	19
Chan (2)	HF dermal	<5	4.2	ND	ND	Asystole	19
Baltazar	NaF oral	ND	4.3	ND	QT^c 360–>450, TW peaked	VF death	14
Rabinowitch	NaF oral	2.0	ND	ND	ND	Death, rhythm ND	15
McIvor 1983	Dialysate	ND	10.5	0.4 mg/L	Biatrial enlargement, LVH	ND
This Patient	HF oral	11.4	5.2	2 mg/L	QT^c 477	VF, VT X 17	27
Burke	HF dermal	15 (post tx)	6.1	ND	ST elevations in L, V1-V3	Bradycardia	37
Abukurah	NaF	Tetany	3.2	ND	NR	VF x 40	16
Stremski	HF oral	6.6	4.0	ND	QT^c 382	VF X 22	11
Greco 1	HF dermal	4.1	ND	0.6 mg/L	QT^c 600	None	6
Greco 2	HF dermal	3.5	ND	0.7 mg/L	ND	None	6
Greco 3	HF dermal	2.5	ND	ND	ND	VF death	6
Mayer	HF dermal	3.3	4.3	42 mg/L	QT^c 280	VT, bradyasystole	5
Bordelon	HF dermal	5.1	Normal	ND	ND	VF x 5	38
Klasner 1	HF oral	4.2	4.7	ND	QT^c 450	VF X 7	2
Klasner 2	HF oral	2.6	5.4	ND	QT^c 480	VF X 2	2
Yamaura	HF dermal	0.44*	4.7	ND	QT^c 510	VT X 8	1
Chan 1997	HF oral	1.91*	3.8	ND	QT^c 375 post-calcium	VF X 6	9
Sanz-Gallen	HF dermal	0.75*	ND	ND	Reported normal	None	7
Manoguerra	HF oral	3.1	ND	35 mg/L	ND	Asystole	39
Takase	HF dermal	4.9	6.2	6.38	ND	Death, rhythm ND	34
Simpson	NaF oral	0.69* (nadir)	5.0 (peak)	1.020 mmol/L	Recurrent VF	Death	12

# ECG intervals are reported in milliseconds.

*mmol/L fraction (normal 1.19–1.32);

HF = hydrofluoric acid; NaF = Sodium fluoride;

VF = ventricular fibrillarion; VT = ventricular tachycardia; ND = not documented.

Fig. 1.  Pre-arrest ECG.

Fig. 2.  a) strip showing ventricular dysrhythmias and b) continuation of same strip with evidence of torsades de pointes.

Fig. 3.  Post-resuscitation ECG.

Yamaura K, Kao B, Iimori E, Urakami H, Takahashi S. Recurrent ventricular tachyarrhythmias associated with QT prolongation following hydrofluoric acid burns. J Toxicol Clin Toxicol 1997; 35(3)311–313

 PubMed Web of Science ®Google Scholar

Klasner AE, Scalzo AJ, Blume C, Johnson P. Marked hypocalcemia and ventricular fibrillation in two pediatric patients exposed to a fluoride-containing wheel cleaner. Ann Emerg Med 1996; 28(6)713–718

 PubMed Web of Science ®Google Scholar