Fluoride Toxicity Clinical Presentation

Updated: Sep 05, 2017
  • Author: Johnathan Ly, MD; Chief Editor: Michael A Miller, MD  more...
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Presentation

History

Determine the exact nature, amount, and time of exposure or ingestion. Query the patient, bystanders, paramedics, and family members regarding specifics of exposure or ingestion, including possible co-ingestants. The presentation may vary in subtle ways depending on the route of exposure, which may be by inhalation, skin contact, or ingestion.

Hydrogen fluoride is a colorless, fuming liquid or gas with an irritating odor. Patients exposed to hydrogen fluoride gas directly or from fumes emanating from concentrated hydrofluoric acid have rapid onset of eye, nose, and throat irritation. 

Cutaneous contact with aqueous hydrogen fluoride leads to rapid, deep tissue penetration that can cause both local cellular destruction and systemic toxicity. Patients may complain of significant cutaneous pain, hemorrhage, or muscular spasm at the site of contact. 

Ingestion of hydrogen fluoride can lead to gastrointestinal symptoms, which may include: nausea, vomiting, and/or gastric pain. However, gastrointestinal symptoms may occur with exposure via any route.

Delayed clinical presentation is quite common. Symptoms may not arise for several days, especially in the case of exposure to dilute solutions of hydrogen fluoride (less than 20%). Consequently, asymptomatic patients should be monitored in the emergency department for 6 hours before possible discharge. Patients may be discharged if asymptomatic and ingestion was less than 3 mg/kg by reliable history. Patients who present with persistent signs and symptoms should be admitted to a monitored bed.

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Physical Examination

Gastrointestinal signs and symptoms, as follows, predominate:

  • Hypersalivation

  • Nausea

  • Vomiting

  • Diarrhea

  • Abdominal pain

  • Dysphagia

  • Mucosal injury

Neurologic effects are as follows:

  • Headache

  • Tremors

  • Muscular spasm

  • Tetanic contractions

  • Hyperactive reflexes

  • Seizures

  • Muscle weakness

Cardiovascular effects are as follows:

  • Widening of QRS

  • QTc prolongation

  • Various arrhythmias

  • Shock

  • Cardiac arrest

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