Fluorine (F2) Hydrogen Fluoride (HF)

1
Fluorine (F2) Hydrogen Fluoride (HF)
2
Fluorine (F2) Hydrogen Fluoride (HF)

• Gaseous element
• Combines with hydrogen to create hydrogen
  flouride gas
• Rarely found in nature
• Used in manufacturing
• Used as a laboratory reagent

3
Fluorine - Overview

• Yellow-green gas
• Intensely irritating odor
• Low odor threshold of 0.035 0.14 ppm
• Most highly oxidizing element known
• Combines directly or indirectly with most
  elements to form fluorides
• Reacts violently with organic compounds, usually
  disintegrating the molecule

4
Hydrogen Fluoride - Overview

• Colorless, fuming liquid or gas
• Strong, irritating odor
• Discernable at 0.04 ppm
• Readily dissolves in water to form colorless
  hydrofluoric acid
• Indistinguishable from water
• Can produce serious health effects by any route
  of exposure

5
Toxicity

• Pulmonary irritant agent
• Severe eye, mucous membrane, and skin effects
• Fluorines lowest toxic concentration for
  inhalation is 25 ppm/5 minutes
• Plasma level of 3 mg/L is fatal
• Hydrogen fluorides estimated lethal dose is 5-10
  gm in adults and 500 mg in small children
• Children may be more vulnerable

6
Toxicity

• Ion penetrates tissues and binds intracellular
  calcium and magnesium
• Cell destruction, local bone demineralization,
  and systemic hypocalcemia, hypomagnesemia, and
  hyperkalemia

7
Toxicity

• Hypocalcemia
• Disrupts oxidative phosphorylation, glycolysis,
  coagulation, and neurotransmission
• Causes tetany, cardiotoxicity, and cardiovascular
  collapse

8
Toxicity

• Inhibits acetylcholinesterase
• Severe toxicity produces multi-organ failure
• Respiratory paralysis, dysrhythmias, or cardiac
  failure results in death

9
Protective Equipment

• Positive-pressure, self-contained breathing
  apparatus (SCBA)
• Chemical protective clothing should be worn

10
Detection

• Rely on chemical sensors, not odor or color
• Monitors and gas sensors widely available

11
Decontamination

• Rapid decontamination is critical
• Move victims from exposure area to fresh air
• Remove and double-bag contaminated clothing and
  personal belongings

12
Decontamination

• Skin exposure
• Flush skin and hair with water or saline for at
  least 30 minutes
• Cover exposed skin with a calcium-containing
  slurry or gel

13
Decontamination

• Eye exposure
• Flush immediately with water for 15 minutes
• Irrigate with saline during transport to the
  hospital
• Use an ophthalmic anesthetic to alleviate
  blepharospasm

14
Signs and Symptoms

• Adverse action may progress days before symptoms
  appear
• Hypocalcemia causes cardiotoxicity, tetany, and
  cardiovascular collapse
• Hyperkalemia may cause ventricular fibrillation

15
Signs and Symptoms

• Inhibition of acetylcholinesterase produces
• Hypersalivation
• Vomiting
• Diarrhea
• Seizures may occur

16
Signs and Symptoms

• Other systemic symptoms
• Coma
• Hypotension (without a compensatory tachycardia)
• Acidosis
• Paresthesias
• Coagulation disturbances

17
Signs and Symptoms

• Acute fluorine exposure
• Eye, nasopharyngeal, skin, and respiratory
  irritation
• Coughing, choking and chills that persist 1-2
  hours

18
Signs and Symptoms

• Acute fluorine exposure
• Severe exposures
• Asymptomatic period of 12-48 hours
• Fever, cough, cyanosis, rales, and tightness in
  the chest develop, leading to pulmonary edema
• Symptoms intensify over 48 hours, then regress
  over 2-4 weeks

19
Signs and Symptoms

• Acute HF (mist or vapor) exposure
• Affects the nose, throat, and eyes initially
• Narrowing and swelling of throat can cause upper
  airway obstruction
• Lung injury may be rapid or delayed
• Pulmonary edema, bronchiolar constriction, and
  partial or complete lung collapse can occur
• Pulmonary effects also result from dermal
  exposure and ingestion

20
Signs and Symptoms

• Skin contact
• Depends on concentration/duration of exposure
• Acid concentrations gt 50 immediate severe,
  throbbing pain white discoloration of skin,
  followed by blistering
• Solutions of 20 to 50 pain and swelling
• Solutions lt 20 limited pain on contact but
  possible serious injury 12 to 24 hours later

21
Signs and Symptoms

• Eye exposure
• Mild exposure rapidly produces eye irritation
• Severe effects
• Sloughing of the eyes surface
• Swelling of various structures of the eye
• Ischemic cell death
• Permanent corneal clouding may develop

22
Signs and Symptoms

• Ingestion
• Small ingestions
• Local GI upset, salivation and a metallic taste
  that may last 48 hours
• Serious ingestions
• Corrosive injury to the mouth, throat, and
  esophagus
• Inflammation of the stomach with bleeding, nausea
• vomiting, diarrhea, abdominal pain

23
Treatment

• After decontamination, follow ABCs of advanced
  life support
• Secure and maintain open airway
• Hypoxia O2 by non-rebreather mask, 10-15 L/min
• Observe closely for signs of pulmonary edema
• Consider early use of IPPB, PEEP mask, or
  intubation

24
Treatment

• Additional pulmonary care
• Use 2.5 calcium gluconate in nebulizer with
  oxygen
• Bronchospasm aerosolized bronchodilators
• Children with stridor racemic epinephrine
  aerosol at a dose of 0.250.75 mL of 2.25
  solution in water, q20 minutes as needed

25
Treatment

• For ingestions
• Do not induce vomiting or give activated charcoal
• Rinse mouth well and give water or milk for
  dilution, if patient able
• One-time dose of a magnesium or calcium antacid
• If lt 1 hour after exposure, consider gastric
  lavage with lime water

26
Treatment

• Dermal burns
• Consult a burn specialist or plastic surgeon
  early
• Pain relief apply calcium gluconate gel
• Large or deep burns inject sterile aqueous
  calcium gluconate into burn site
• Burned digits intra-arterial calcium gluconate
• Do not inject or use calcium chloride

27
Treatment

• Ocular burns
• Immediately consult an ophthalmologist
• Do not use oils, salves, or ointments
• Do not use the gel form of calcium gluconate

28
Long-Term Medical Sequelae

• Severe inhalation exposure may result in chronic
  lung disease
• Burns can take months to heal
• Fingertip injuries can be debilitating

29
Long-Term Medical Sequelae

• Visual defects, blindness, or complete eye
  destruction can occur
• Ingestion may damage the esophagus and stomach
  progressively
• EPA Group D carcinogenicity, reproductive, and
  teratogenetic effects are not known

30
Environmental Sequelae

• Fluorine is highly reactive
• Does not persist in environment
• Forms fluoride salts in soil
• Dissolves in water

31
Summary

• Fluorine and hydrogen fluoride are toxic gases
• Severe eye, mucous membrane, and skin effects
• Fluoride ion aggressively penetrates tissues and
  binds intracellular calcium and magnesium
• Cell destruction, local bone demineralization,
  and systemic hypocalcemia, hypomagnesemia, and
  hyperkalemia

32
Summary

• Hypocalcemia disrupts cell function
• Tetany, cardiotoxicity, and cardiovascular
  collapse
• Treatment is supportive
• Early use of IPPB, PEEP, or intubation may
  prevent / delay pulmonary edema
• Long-term medical problems are possible