Letale Intoxikation mit Zinkhexafluorosilikat (Flusssäure)

Intoxication with hydrofluoric acid is a rare but mostly lethal clinical condition. We report on a female who swallowed approximately 30 ml of Hexafluorosilicate (Hydrofluoric acid) during an attempt to commit suicide. The woman was found somnolent in a condition of circulatory shock. She had to be intubated and was admitted to hospital. Laboratory investigations showed severe electrolyte disturbances (hypokalemia, hypocalcemia, hypophosphatemia and low magnesium levels) as well as severe metabolic acidosis. Within the next few hours, a disseminated intravascular coagulation developed. Serum fluoride levels were 1.98 mg/l (normal values < 0.03 mg/l). Although the electrolyte abnormalities had been corrected, the clinical condition worsened. The patient had to be defibrillated due to ventricular fibrillation about 30 times. Over time, these episodes of ventricular fibrillation became less responsive to defibrillation. After 12 h, the patient died under cardiopulmonary resuscitation due to cardiogenic shock. On autopsy, severe mucosal burns were found and hyperemic lesions were seen in the renal tubular system as well as necrotic lesions in the cardiac musculature. Besides the poor prognosis of a fluoride intoxication in this dosis, the long time interval until treatment could be started seems to be one of the main reasons for the fatal outcome of this case.