Approach Considerations
For prehospital care, emergency medical services personnel should place patients with a known significant ingestion of fluoride on a cardiac monitor and establish intravenous (IV) access. IV calcium should be administered to patients with cardiac dysrhythmias.
In general, victims who have been exposed to hydrogen fluoride gas or vapor do not pose a substantial risk of contamination to prehospital providers. The exception is when a victim's clothing or skin has come in contact with a significant amount of hydrogen fluoride liquid, solution, or condensed vapor.
In the emergency department, rapid decontamination is critical. Any cutaneous exposure should be treated with calcium-containing gels.
The patient should be placed on a cardiac monitor and an electrocardiogram should be obtained. Correct electrolyte abnormalities, especially hyperkalemia, hypocalcemia, and hypomagnesemia. Correct calcium deficiencies with IV calcium chloride or calcium gluconate. Cardiac arrhythmias from fluoride toxicity are difficult to treat because they do not respond to lidocaine, cardioversion, or defibrillation.
Perform gastric aspiration and lavage. Small-bore nasogastric tube aspiration, followed by lavage, is recommended because of the potential severity of this ingestion and the ineffective adsorption of fluoride to activated charcoal. Although fluoride does not bind to activated charcoal, use of activated charcoal is still recommended for patients with intentional ingestions when a polysubstance overdose is possible.
Lavage with milk or a solution containing calcium carbonate or magnesium hydroxide (eg, milk of magnesia) is theoretically attractive but has not been proven beneficial. Lavage with 1%-5% calcium chloride solution has been recommended, to bind fluoride in the stomach. Gastric aspiration and lavage are most effective when instituted within 1 hour of ingestion. Hemodialysis is used for critically ill patients whose condition is refractory to all other forms of treatment.
Consult a toxicologist or poison control center for current acute management recommendations. For intentional ingestions, consider psychiatric consultation after medical clearance.
