Acute Fluoride Toxicity Due to Intentional Ingestion of Hydrofluoric Acid Commercial Product

Hydrofluoric (HF) acid, an irritating and corrosive acid, is commonly found in cleaning supplies. Fatal HF acid ingestion has been documented, although relatively rare. We report a case of acute fluoride toxicity suicide due to the ingestion of a commercial product containing HF acid and ammonium bifluoride. To our knowledge, this is the first to describe the associated gastrointestinal histopathology in detail.A 56-year-old woman was found deceased near a rust remover product and a notebook containing suicide methods via chemical ingestion. Gross autopsy findings included laryngeal mucosal petechial hemorrhages; patchy esophageal mucosal denudation; and autolyzed, red-black discolored gastric mucosa. Histology of the esophagus demonstrated superficial mucosal ulceration with necrosis of the squamous mucosa, vascular congestion, and lymphoid aggregates in the lamina propria; muscularis mucosae and muscularis propria were unperturbed. The stomach showed superficial coagulative necrosis of the oxyntic crypts, with fresh microhemorrhage dissecting the glandular mucosa away from the muscularis mucosae; muscularis mucosae, submucosa, muscularis propria, and serosa were all spared.Toxicology revealed an elevated fluoride ion concentration (20 mg/L). Death was attributed to acute fluoride toxicity due to intentional ingestion of a commercial product containing HF acid and ammonium bifluoride, and the manner was suicide.