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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 31, Number 8, October,
pp.526-533
CASE REPORT: The Tissue Distribution of
Fluoride in a Fatal Case of Self-Poisoning
María A. Martínez[1], Salomé Ballesteros[1],
Francisco J. Piga[1], Carolina Sánchez de la Torre[1],
and Carlos Cubero[2]
[1]National Institute of Toxicology and Forensic Sciences, Ministry
of Justice, C/ Luis Cabrera 9, 28002 Madrid, Spain and
[2]Legal
Medicine Institute, C/ Barroeta Aldamar 10, 48001 Bilbao, Spain
The purpose of this paper is to report a case
of fluoride poisoning along with a discussion of poisoning characteristics,
analytical procedures, and a review of previous reports of fatal
intoxications with analytical data. A case of suicidal ingestion
of 40 mL of a rust removal agent containing hydrofluoric acid
and ammonium fluoride by a 33-year-old white male is presented.
He had an organic personality disorder with residual schizophrenia
and previous suicide attempts with therapeutic drugs and cleaning
products. At admission, he presented with a Glasgow coma score
of 3, third degree atrioventricular block, and asystole. Resuscitation
efforts were performed during which the patient suffered two
episodes of ventricular fibrillation followed by asystole. In
spite of advanced resuscitation efforts and the administration
of calcium chloride, he died 2.5 h after the ingestion. Analytical
data in the hospital showed calcium levels of 3.1 mg/dL and metabolic
acidosis. Internal findings were erosive gastritis, brain edema,
and pulmonary and hepatic congestion. Quantitation of fluoride
was performed using an ion-selective electrode for the anion.
Disposition of fluoride in the different tissues was as follows:
peripheral blood, 19.4 mg/L; urine, 670 mg/L; vitreous humor,
2.5 mg/L; liver, 40.0 mg/kg; kidney, 60.0 mg/kg; lung, 17.5 mg/kg;
brain, 2.5 mg/kg; spleen, 30.0 mg/kg; bone, 0.5 mg/ kg; and gastric
content, 1120 mg/L (67 mg total). Validation of the analytical
method was performed using different spiked tissues, in a range
of concentrations from 2.4 to 475 mg/L or mg/kg, and submitting
them to dilution (1:25) to avoid the matrix effect and to bring
these concentrations to the range of the aqueous calibration
curve (0.19–19 mg/L). Limits of detection and quantitation
were 0.02 and 0.1 mg/L, respectively. The linearity of the method,
for all studies tissues, was excellent, with r2 values of 0.999.
Accuracy and precision were within 10.5% and 5.7%, respectively.
Fluoride analyses using the ion selective electrode are simple,
sensitive, and rapid. This report provides an extensive tissue
distribution study of fluoride after a well documented case of
acute poisoning. Based on the autopsy findings, patient history,
toxicology results, and previously reported data the forensic
pathologists ruled that the cause of death was due to a fluoride
poisoning, and the manner of death was listed as suicide.
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