A case of torsades de pointes on continuous hemodialysis in a patient with acute fluoride intoxication

DOI 21 References
  • Hifumi Toru
    Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
  • Watanabe Yoshihiro
    Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
  • Yoshioka Hayato
    Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
  • Hasegawa Eiju
    Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
  • Haraguchi Yoshikura
    Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
  • Kato Hiroshi
    Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
  • Koido Yuichi
    Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
  • Homma Masato
    Division of Emergency and Disaster Medicine, Tottori University Faculty of Medicine

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Other Title
  • 持続的血液透析中にtorsades de pointesを生じたフッ化水素中毒の1例

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A 39-year-old man accidentally ingested a cleaning solution containing 1.3% hydrofluoric acid and 10% ammonium fluoride. He was brought to our hospital within half an hour of this episode. He was fed milk via a nasogastric tube and admitted to the ICU. As a treatment for prolonged hypocalcemia, calcium gluconate was administered. Continuous hemodialysis (CHD) was performed because of rapidly progressive hyperkalemia. Within 4 hrs of hospitalization, his blood potassium level increased rapidly. Torsades de pointes (TdP) developed suddenly 7 hrs after his admission to the hospital; 2 g of magnesium sulfate was administered immediately and the cardiac rhythm was restored. At the time of TdP, his blood K level was found to be 3.97 mEq·l−1. During CHD and after Ca administration, his blood Ca level was found to be 7.68 mg·dl−1. However, the Mg level was as low as 0.8 mg·dl−1, and this was suspected to be the cause of TdP. The Mg concentration of the fluid used for CHD has been adjusted to 1.2 mg·dl−1, which is the concentration used for patients with chronic renal failure. Therefore, this concentration was not appropriate for our patient with hypomagnesemia.

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