Case Files of the Toxikon Consortium in Chicago: Survival after Intentional Ingestion of Hydrofluoric Acid

Abstract

Keywords Caustic ingestion.Fluoride.Hypocalcemia.HyperkalemiaCase PresentationA 19-year-old man with a history of past suicide attemptspresented to the emergency department (ED) with severeabdominal pain. The patient’s sister stated that, 30 min priorto presentation, the patient had tried to kill himself bydrinking “poison.” Per the patient, he drank about 120 mLof a cleaning agent immediately prior to informing hissister. The patient then had one bout of blood-tingedvomiting, so the sister activated emergency medicalservices (EMS). EMS arrived and transported the patientuneventfully to the ED while establishing an IV en route.Uponarrival tothe ED,thepatienthadapulserateof80/min,blood pressure of 150/90 mmHg, respiratory rate of 18/min,and oxygen saturation of 99% on room air.Soon after arrival to ED, the poison control center wascontacted by the emergency medicine physician. Byhistory, it was determined that the ingested cleaning agentwas likely a brick-cleaning solution, although the ED staffwere unable to definitively identify the composition at thistime. The patient developed profound hematemesis within15 min of arrival to the ED. He was endotracheallyintubated for airway protection using 20 mg of etomidateand5mgofmidazolam.Famotidine40mgIVwasgivenandapropofol infusion was started for sedation. Due to the rapidprogression of symptoms and recognition that many brick-cleaning solutions contain hydrofluoric acid (HFA), the poisoncenterspecialistimmediatelyforwardedthecasetothemedicaltoxicology consult service. Per telephone recommendation bythe toxicology consultants,a nasogastric(NG) tube wasplacedand suction was started with minimal liquid return. This wasfollowedby30mLofmilkofmagnesiagivenviatheNGtube.An EKG was ordered, and a complete set of labs were sentincluding arterial blood gases. Ampules of 10% calciumgluconate were placed at bedside per toxicologist recommen-dation. One hour after presentation, initial lab results includedpH 7.24, PaCO