Fluorine (F 2 ) 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 • Fluorine’s lowest toxic concentration for inhalation is 25 ppm/5 minutes • Plasma level of 3 mg/L is fatal • Hydrogen fluoride’s 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 > 50%: immediate severe, throbbing pain; white discoloration of skin, followed by blistering • Solutions of 20% to 50%: pain and swelling • Solutions < 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 eye’s 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 ABC’s 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 0.25–0.75 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 < 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