A Case of Fluoroacetamide Poisoning Alleviated by Hemodialysis

Abstract

Fluoroacetate poisoning, usually caused by exposure to sodium monofluoroacetate and fluoroacetamide, competitively inhibits aconitase in the tricarboxylic acid cycle. There are no effective antidotes, and treatment is symptomatic and supportive. The effectiveness of hemodialysis in alleviating fluoroacetate poisoning remains unclear, and no study has reported changes in the blood concentration of fluoroacetate after hemodialysis. A 71-year-old man with a history of chronic kidney disease and on maintenance hemodialysis had findings suggestive of acute fluoroacetate poisoning. He presented with tachycardia, tachypnea, renal dysfunction, hyperammonemia, and hyponatremia. He was intubated with a nasogastric tube and administered intravenous fluids, and direct hemoperfusion and hemodialysis were performed on successive days to reduce blood fluoroacetate concentrations. He recovered without organ failure and was transferred for rehabilitation. This is the first study to report a case wherein treatment with hemodialysis reduced fluoroacetate concentrations, suggesting hemodialysis can be an effective treatment strategy for fluoroacetate poisoning.