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Sulfuryl Fluoride Poisoning
Aka: Sulfuryl Fluoride Poisoning, Sulfuryl Fluoride Toxicity, Sulfuryl Fluoride
- Background
- Sulfuryl Fluoride is a gas used to fumigate coastal structures for termites
- Gas is colorless and odorless and accumulates in low areas (heavier than air)
- Humans are exposed via inhalation of gas
- Exposure limit over short term is 10 ppm
- Toxic or lethal dose 200 ppm
- Adverse Effects
- Electrolytes
- Hypocalcemia
- Hypomagnesemia
- Cardiovascular
- Arrhythmia
- QRS Widening
- QTc Prolongation
- Hemodynamic instability
- Gastrointestinal
- Nausea or Vomiting
- Diarrhea
- Abdominal Pain
- Respiratory
- Cough
- Dyspnea
- Pulmonary congestion
- Neurologic
- Paresthesias
- Agitation
- Seizures
- Altered Level of Consciousness to coma
- Labs
- Serum Electrolytes and acid-base
- Serum Calcium Decreased
- Serum Magnesium decreased
- Serum Potassium decreased
- Acidosis
- Diagnostics
- Electrocardiogram
- QRS Widening
- QTc Prolongation
- Management
- Remove patient from exposure
- Decontamination
- ABC Management
- Electrolyte replacement
- Hypocalcemia Management
- Hypomagnesemia Management
- Hypokalemia Management
- Arrhythmia Management
- Consider Amiodarone for Ventricular Arrhythmia
- Seizure Management
- See Status Epilepticus
- Consider phenobarbital for refractory Seizures (after initial Benzodiazepines)
- Disposition - Emergency discharge indications (all others should remain for hospital observation)
- Observed for 4-6 hours without symptoms
- No acute EKG abnormalities (QTC normal, QRS width normal)
- No Hemodynamic instability
- References
- Tomaszewski (2020) Crit Dec Emerg Med 34(11): 28