Sudden cardiac death from acute fluoride intoxication: The role of potassium

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

“…However, our literature search showed that clinically consequential levels of hyperkalemia have been conclusively demonstrated only in cases of poisoning with sodium fluoride or sodium silicofluoride (22,27). Studies in canine models also utilized sodium fluoride (24,25). Three cases of HFassociated dermal injuries have documented or inferred elevations in serum potassium levels, but the association with cardiac dysfunction in each case is questionable.…”

“…As a therapy aimed specifically at preventing hyperkalemia, the reported ability of quinidine to prevent death in a dog model of fluoride poisoning (24) suggests that this agent, as well as amiodarone, deserve further evaluation of their protective effects on the myocardium in fluoride poisoning. Experiments demonstrating the attenuation of hyperkalemia by insulin, amiodarone, or quinidine in in vitro erythrocyte suspensions are provocative, but more direct evidence of myocardial protection from these agents is necessary in order for them to be considered clinically as antidotes (18,(23)(24)(25)(26). Another important question is whether the use of bicarbonate for empirical treatment of hyperkalemia might exacerbate hypocalcemia due to the recognized effects of alkalinization on ionized serum calcium.…”

“…Hyperkalemia, which may be delayed in onset, has also been proposed as an etiology of fluoride-associated ventricular dysrhythmias (4,18,(23)(24)(25)(26)(27). Hyperkalemia has been documented in a number of cases of human poisoning with fluoride (22,27) and in dog studies of fluoride poisoning (24,25). In vitro studies of erythrocyte suspensions show that sodium fluoride induces potassium efflux from erythrocytes (18,(23)(24)(25)(26)28).…”

“…Hyperkalemia has been documented in a number of cases of human poisoning with fluoride (22,27) and in dog studies of fluoride poisoning (24,25). In vitro studies of erythrocyte suspensions show that sodium fluoride induces potassium efflux from erythrocytes (18,(23)(24)(25)(26)28). Due to uncertainty regarding the relative contributions of hypocalcemia and/or hyperkalemia to the development of ventricular dysrhythmias, appropriate therapies remain controversial.…”

Differential expression of myocardial heat shock proteins in rats acutely exposed to fluoride

“…Hsps are among the major defensive stress proteins, which play an important role in the pathophysiology of various xenobiotic-induced cardiotoxicity models (Shan et al 2003;Yu et al 2012). Acute F − poisoning is known to cause sudden cardiac failure in both humans (Vohra et al 2008;Lech 2011) and experimental animals (McIvor et al 1987). Our previous study showed that acute F − exposure impairs cardiac dysfunction through increased mitochondrial oxidative damage, apoptosis, and necrosis in rat myocardium .…”