Toxicity from Repeated Low-Grade Exposure to Hydrogen Fluoride — Case Report

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Abstract
HF can cause topical and systemic poisoning. In contact with the skin it may induce deep, extremely painful ulcers, which are believed to be due to its ability to penetrate the skin in an undissociated state, and to its subsequent ionization when in contact with body fluids. Because of its strong affinity for water, HF hydrolyzes to hydrofluoric acid, that causes a strong conjunctival and upper respiratory irritation. Chronic, long-term exposure to HF causes skeletal fluorosis, i.e., osteosclerosis, periosteal appositions of bone, and calcification in ligaments and joints. Undoubtedly because of its widespread industrial use, HF is not an uncommon cause of chronic low-grade exposure, but the disease has not been described in the literature prior to the onset of the typical bone changes. This is not surprising since the initial stage, like that of many other kinds of chronic poisoning, develops slowly and insidiously with ill-defined complaints that are difficult to attribute to their cause. For instance, in Pb poisoning the charactersitic hallmarks are lead line of gums and radial nerve paralysis; in chronic Cd poisoning, one sees softening of bones. They are always preceded or accompanied by a variety of subtle, inconspicuous symptoms of the kind encountered in incipient, chronic fluoride poisoning. Subclinical poisoning can harm vast numbers of people before obvious clinical symptoms appear. These multiple, hidden effects of slow poisoning pose a strong challenge to current concepts of safe limits of toxic substances in the environment. A case report of a worker is given.

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