title: The electrocardiographic toxidrome: the ECG presentation of hydrofluoric acid ingestion.
abstract: The clinician can approach the poisoned patient using the toxidrome system of toxin identification; this approach makes use of findings noted on the physical examination, highlighting the importance of abnormalities in blood pressure, heart rate, respiratory effort, body temperature, mental status, pupillary size, skin color, diaphoresis, and gastrointestinal sounds. Such a method provides structure and guidance to the clinical evaluation, providing the clinician with rapid diagnostic information and suggesting urgent management issues. A case of hydrofluoric acid poisoning is used as an example of this diagnostic approach. The patient demonstrated systemic toxicity accompanied by oral irritation and electrocardiographic abnormality (QRS complex widening and QT interval prolongation). The constellation of these findings suggested the possibility of a caustic agent (history and examination) with potential effect on potassium and calcium metabolism (electrocardiographic abnormalities). Such a constellation strongly suggested hydrofluoric acid as the culprit toxin.
authors.affiliation: Department of Emergency Medicine, University of Virginia Medical Center, Charlottesville, 22908, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Holstege
authors.forename: Andrew
authors.initials: A
authors.lastname: Baer
authors.forename: William J
authors.initials: WJ
authors.lastname: Brady
mesh_terms: D000138:Acidosis / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D002637:Chest Pain / Q000139:chemically induced; D003937:Diagnosis, Differential; D004326:Drinking; D004562:Electrocardiography; D004635:Emergency Medicine / Q000379:methods*; D006801:Humans; D006858:Hydrofluoric Acid / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D011041:Poisoning / Q000175:diagnosis / Q000628:therapy; D013616:Tachycardia, Sinus / Q000139:chemically induced* / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
chemical_list: D006858:Hydrofluoric Acid