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


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
Ventricular dysrhythmias due to HF toxicity seem to be independent of either hypocalcemia or hyperkalemia. Systemic toxicity after ingestions may be delayed and precipitous.
Vohra
Rais
R
University of Texas, Southwestern Medical Center at Dallas, Dallas, Texas 75390-8579, USA.
Velez
Larissa I
LI
Rivera
Wilfredo
W
Benitez
Fernando L
FL
Delaney
Kathleen A
KA
D000369:Aged, 80 and over; D002122:Calcium Chloride / Q000627:therapeutic use; D004554:Electric Countershock; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006858:Hydrofluoric Acid / Q000506:poisoning*; D006996:Hypocalcemia / Q000139:chemically induced / Q000188:drug therapy; D008012:Lidocaine / Q000627:therapeutic use; D008274:Magnesium / Q000627:therapeutic use; D017180:Tachycardia, Ventricular / Q000139:chemically induced*; D014693:Ventricular Fibrillation / Q000139:chemically induced*
D008012:Lidocaine; D008274:Magnesium; D002122:Calcium Chloride; D006858:Hydrofluoric Acid