Ammonium Bifluoride Poisoning: Our Eight-year Experiences

Abstract

Introduction: The aim of the study was to discuss clinical effects, treatment options and outcomes of pediatric ammonium bifluoride (ABF) poisoning. Methods: This study was designed as retrospective case series. We analyzed the medical records of children who were hospitalized for ABF poisoning between January 2009 and October 2017. Results: The median calcium level on arrival to the hospital was 9.26 mg/dL (minimum-maximum: 4.6-10.9). The median calcium level 2 hours after arrival was 6.44 mg/dL (minimum-maximum: 2-9.2). One patient arrived at the hospital within 3 hours after poisoning and the calcium level on arrival was 4.8 mg/dL. It means that the time elapsed between ABF ingestion and hospital arrival is one of the most important prognostic factors for survival. In our practice, we start 25-75 mg/kg calcium gluconate infusion for hypocalcemia. In our two cases inappropriate dose of calcium gluconate infusion was given to the patients (5 mg/kg in one and 20 mg/kg in the other patient) and both of them died. Conclusion: Although it is a rare condition, this study probably represents the largest sample of patients with pediatric ABF poisoning. Patients, who received oral calcium lactate therapy in addition to intravenous calcium therapy, survived despite the presence of life-threatening ventricular dysrhtymias. We assume that oral calcium lactate therapy was associated with improved survival in ABF toxicity. Future studies on oral calcium lactate therapy and its effects on the survival are needed.

Keywords

• Ammonium bifluoride
• poisoning
• calcium lactate
• dysrhtymias