Fatal systemic fluorosis due to hydrofluoric acid burns

Mayer, Theodore; Gross, Peter L.

doi:10.1016/s0196-0644(85)81078-7

Cited by 80 publications

(21 citation statements)

References 19 publications

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“…Fluoride also binds to potassium and magnesium ions leading to myocardial irritability and arrhythmia. Chronic exposure to HF may cause skeletal fluorosis that can be fatal [53][54][55][56].…”

Section: Systemic Toxicitymentioning

confidence: 99%

Possible hazardous effects of hydrofluoric acid and recommendations for treatment approach: a review

2011

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Hydrofluoric acid (HF) is commonly used for conditioning the glass ceramics either prior to cementation or for intraoral repair in prosthetic and restorative dentistry. The present study offers a review of chemical properties of HF used, highlight the possible hazardous effects of this agent, and to recommend the treatment approach for potential risks. Available published information documented in PubMed, Medline, and Picarta literature databases was reviewed. Additional information was derived from scientific reports, medical and chemical textbooks, handbooks, product information, manufacturers' instructions, Internet web sites of the HF manufacturers. No report was found on the incidence of the hazardous effects of HF in dentistry. Reports from other fields presented incidences of acute and chronic symptoms in exposure to HF. While acute symptoms include skin or nail burns, chronic ones involve systemic toxicity, eye injuries, inhalation and ingestion-related symptoms that can be even fatal. HF can be harmful and particularly aggressive to soft tissues, but symptoms may not be apparent immediately after exposure. The hazardous effects are not based on the pH value, but on the toxicity of HF. Potential hazards of HF known from other applications than dentistry should be considered also in dental applications. Especially the clinicians, who often deal with adhesive cementation or repair of glass ceramics, should take necessary precautions for possible hazards of HF. Scientific reports, medical and chemical textbooks, handbooks, product information, manufacturers instructions, Internet web sites of the HF manufacturers were also referred. In dentistry, HF is most commonly used for conditioning the glass ceramics either prior to cementation or for intraoral repair.Exposure to HF can be harmful and may not be immediately apparent being particularly aggressive for soft tissues. This is not based on the pH value, but on its toxicity. Common routes of exposure are inhalation, dermal exposure and ingestion that lead to the general symptoms of toxicity such as lung injury, skin burns, systemic toxicity and painful necrotic lesions. General symptoms are skin burns, systemic toxication and eye irritation by fume exposure. No report was found on the hazardous effects of HF in dentistry. HF is commonly used to condition the ceramic surfaces prior to cementation or repair. Especially the clinicians, who often deal with glass ceramics, should take necessary precautions for possible hazards of HF.

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Section: Systemic Toxicitymentioning

confidence: 99%

Possible hazardous effects of hydrofluoric acid and recommendations for treatment approach: a review

2011

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“…The concentration of HF in household products is usually less than 10%, while industrial products may have concentrations as high as 70% (3). Acute systemic toxicity from HF occurs through dermal exposure to highly concentrated solutions, and through ingestion (1,2,(4)(5)(6)(7)(8)(9)(10)(11). Ingestion of the sodium salt form of HF (NaF), which was historically used as a pesticide, resulted in many deaths (12)(13)(14)(15)(16).…”

Section: Introductionmentioning

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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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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“…The uncorrected depletion of these vital electrolytes can result in fatal ventricular dysrhythmias including ventricular tachycardia and ventricular fibrillation. Unfortunately, even correctly identifying this toxicity does not always prevent fatal outcomes.There are many documented cases of ventricular dysrhythmias refractory to treatment with intravenous calcium and magnesium [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Finger Pain out of Proportion to Exam: A Case of Occult Hydrofluoric Acid Toxicity

Bassett¹

2015

Med chem

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IntroductionHydrofluoric acid toxicity can have significant morbidity and even mortality associated with seemingly small exposures.The impact of significant electrolyte disturbances can lead to sudden cardiac collapse.Owing to a delayed time to symptom onset, low concentration exposures may present as a diagnostic dilemma.The patient's lack of association between exposure and symptoms may eliminate key historical information.Additionally the lack of physical exams findings associated with low concentration HFA exposure adds to the challenges of making the correct diagnosis.We present a case of a 21-year-old male who presented to the emergency department with finger pain out of proportion to physical exam findings and no clear exposure to HFA. This case illustrates the importance of considering HFA toxicity in all unknown chemical exposures. Case ReportA 21-year-old male presented to the emergency department 12 hours after using a cleaning agent that was supplied by his employer to shine metal trim.The patient reported using non-waterproof gloves and no direct contact with the cleaning agent.Approximately one hour after using the cleaning agent, the patient reported feeling a painful prickly sensation that progressively worsened.The patient reported "multiple" visits to the sink to perform standard hand washing.The patient attempted using 1 dose of an oral non-steroidal anti inflammatory drug and a topical antibiotic ointment to sooth his discomfort without relief. Over the course of the next 8 hours the pain became intolerable and the patient presented to the hospital.Upon arriving at the emergency department the patient's vital signs included a blood pressure 143/102, heart rate 104, respiratory rate 22 per minute, temperature of 36.5°C, and an oxygen saturation of 99% on room air.His physical exam was unremarkable except for his hands.The palmar surface of all 5 distal digits on the right hand and the palmar surface of the distal left thumb demonstrated mild erythema.The first 3 digits on the right also demonstrated some minimal whitening on the distal tips.There was no edema, blisters or ulcerations.Neurologically the patient was completely intact including 2-point discrimination over the affected area.The patient empirically received an appropriate weight-based dose of morphine and ondansetron and a 1-literintravenous bolus of 0.9% NaCl solution. Basic laboratory tests were performed that included a complete blood count, a comprehensive metabolic profile, and coagulation studies.Initial studies revealed a white blood cell count of 14.32 x10 9 /L, sodium 139 mEq/L, bicarbonate 17 mEq/L, chloride 107 mmol/L, potassium 3.5 mmol/L, ionized calcium 1.09 mmol/L (normal: 1.18-1.29 mmol/L), magnesium 1.7 mg/dl (normal: 1.8-2.4 mg/dl).X-rays of the hand demonstrated no bony abnormality or foreign body. A 12-lead EKG was performed which demonstrated a normal sinus rhythm, without peaked t-waves, and normal intervals including the corrected Q-T interval.Based on the suspicion for HFA exposure, in conjunction with a med...

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Fatal systemic fluorosis due to hydrofluoric acid burns

Cited by 80 publications

References 19 publications

Possible hazardous effects of hydrofluoric acid and recommendations for treatment approach: a review

Possible hazardous effects of hydrofluoric acid and recommendations for treatment approach: a review

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

Finger Pain out of Proportion to Exam: A Case of Occult Hydrofluoric Acid Toxicity

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