Abstract

Case reports are presented of 8 patients with end stage renal disease who while undergoing dialysis received IV, excessive amounts of fluoride due to an unreported spill of hydrofluosilicic acid into the public water supply caused by cross connections in a treatment plant. Water used to mix dialysis solutions in this unit was treated only by a softening device; no reverse osmosis or deionization had occurred. The afebrile illness, predominantly characterized by hypotension, nausea, substernal pain, diarrhea, itching, and vomiting, developed after one to 2 hr of dialysis. One patient upon autopsy was found to have high fluoride levels in lung tissue (5.6 ppm), kidney (7.0 ppm), brain (0.9 ppm) and blood (4.9 ppm). When a chemical accident does occur, public health officials should be immediately informed so that dialysis units and End Stage Renal Disease Networks in particular can be promptly notified. Finally, it is recommended that water purification techniques such as reverse osmosis and deionization be used to ensure high quality dialysate.

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