Abstract
A 39-year-old man accidentally ingested a cleaning solution containing 1.3% hydrofluoric acid and 10% ammonium fluoride. He was brought to our hospital within half an hour of this episode. He was fed milk via a nasogastric tube and admitted to the ICU. As a treatment for prolonged hypocalcemia, calcium gluconate was administered. Continuous hemodialysis (CHD) was performed because of rapidly progressive hyperkalemia. Within 4 hrs of hospitalization, his blood potassium level increased rapidly. Torsades de pointes (TdP) developed suddenly 7 hrs after his admission to the hospital; 2 g of magnesium sulfate was administered immediately and the cardiac rhythm was restored. At the time of TdP, his blood K level was found to be 3.97 mEq·l−1. During CHD and after Ca administration, his blood Ca level was found to be 7.68 mg·dl−1. However, the Mg level was as low as 0.8 mg·dl−1, and this was suspected to be the cause of TdP. The Mg concentration of the fluid used for CHD has been adjusted to 1.2 mg·dl−1, which is the concentration used for patients with chronic renal failure. Therefore, this concentration was not appropriate for our patient with hypomagnesemia.
