US EPA

5097390 

Journal Article 

Abstract 

Hyperphosphatemia and cardiac arrest following inhalation of a dry chemical fire extinguisher 

Doyon, S; McGrath, JM 

2003 

1 

Journal of Toxicology: Clinical Toxicology
ISSN: 0731-3810
EISSN: 1097-9875 

41 

5 

609-640 

English 

Background: No systemic toxicity is reported from inhalation of dry chemical fire extinguisher. We report the first case of life-threatening hyperphosphatemia, hypocalcemia and cardiac arrest following exposure to a fire extinguisher.

Case Report: A 46 y. o. woman with a history of depression and asthma inhaled the fumes of Ansul Foray? dry chemical extinguishing agent (containing ammonium phosphate monobasic) in a suicidal attempt. She presented in extremis, pulse rate 147/min, BP 119/65 mmHg, RR 32-36/min, Pulse Oximeter (RA) 74%, and T 98?F. ABG (100%): 7.07/59/162, electrolytes were normal except HCO3 20 mEq/L and anion gap 24. Approximately 4 hours later, she had a cardiac arrest and required intubation and ventilation. Abnormal labs were: HCO3 13 mEq/L (21?32), calcium and lt; 5.0 mg/dL (8.4?10.0), phosphate 9.8 mg/dL (2.5?4.9). Osmol gap, salicylates, APAP, ethylene glycol, methanol, and ethanol were negative. She subsequently experienced three episodes of ventricular fibrillation requiring defibrillation. Vasopressors, sodium bicarbonate, calcium chloride, and hemodialysis were intiated. She completely recovered.

Conclusion: Significant hyperphosphatemia and hypocalcemia may occur after inhalation of ammonium phosphate monobasic and may result in cardiac arrest. Hemodialysis is effective at correcting these life-threatening electrolyte abnormalities and is a valid therapeutic option. 

2003 North American Congress of Clinical Toxicology Annual Meeting