Notes from the Field: Acute Sulfuryl Fluoride Poisoning in a Family – Florida, August 2015

Details

• Journal Article:
  Morbidity and Mortality Weekly Report
• Personal Author:
  Mulay, Prakash R. ; Clark, Grethel ; Jackson, William L. ; Calvert, Geoffrey M.
• Description:
  On August 19, 2015, the Florida Department of Health (FDOH) was notified by the Florida Poison Information Center Network and a local hospital of possible sulfuryl fluoride poisonings affecting a family in Martin County, in southeastern Florida. Sulfuryl fluoride is a highly toxic (toxicity category I) gas fumigant used for termite control of homes and buildings. FDOH personnel in Martin County commenced an investigation and identified a family of five (a grandmother, mother, father, son, and daughter) exposed to sulfuryl fluoride after their house was fumigated. The Florida Department of Agriculture and Consumer Services (FDACS), and the U.S. Environmental Protection Agency (EPA) Criminal Investigation Division also conducted an investigation after being notified by FDOH. Medical records were reviewed, and the father was interviewed by FDOH. On August 14, 2015, the house was fumigated with sulfuryl fluoride to eradicate a dry-wood termite infestation. At 4:00 p.m. on August 16, approximately 48 hours after the fumigation began, the family was permitted to reenter the house. That evening, the mother and son developed nausea and vomiting. By 6:00 a.m. the next morning, all family members had similar symptoms, prompting all family members except the father to visit a hospital emergency department. The grandmother, mother, and daughter were released the same day with diagnoses of chemical inhalation. The son, a previously healthy boy aged 9 years, was found to have altered mental status, dysarthria, dystonia, rigidity, and hyperreflexia, but was alert and answering questions. He was treated with calcium gluconate to correct hypocalcemia; other laboratory tests were normal, and a urinary toxicology profile was negative. He was admitted to the pediatric intensive care unit and was intubated for the first 2 days of hospitalization for airway protection from aspiration. Computerized tomography scan of the brain showed no cerebral edema or evidence of bleeding. On August 18, he developed choreoathetosis that progressed to involve both arms, legs, and both sides of his face; a brain magnetic resonance imaging study was consistent with basal ganglia injury. He underwent two rounds of hemodialysis to assist with fluoride ion removal, although documentation of his serum fluoride concentration was not found in the medical record. After excluding carbon monoxide and heavy metal poisoning, anoxic brain injury, and metabolic disorders, the treating physicians attributed his neurologic findings to sulfuryl fluoride poisoning, manifested by basal ganglia necrosis. Because there is no specific antidote for sulfuryl fluoride poisoning, his management was supportive; symptoms improved slightly during hospitalization, although dysarthria and choreoathetosis continued. On September 4, he was transferred to a rehabilitation facility where he experienced some additional improvement, but continued to have expressive aphasia and choreoathetoid movements of the face, trunk, and extremities. He was released on September 25, 2015. [Description provided by NIOSH]
• Subjects:
  Air Pollutants, Occupational Family Hazardous Substances Occupational Health Poisoning Safety
• Keywords:
  Surveillance-programs; Poisons; Poison control; Sulfuryl fluoride; Toxic gases; Toxic vapors; Poison gases; Fumigants; Families; Pest control
• Source:
  MMWR 2016 Jul; 65(27):698-699
• Series:
  Weekly Report: Morbidity and Mortality Weekly Report (MMWR)
• ISSN:
  0149-2195
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Florida ; Ohio ; OSHA Region 4 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  2 pdf pages
• Volume:
  65
• Issue:
  27
• NIOSHTIC Number:
  nn:20048433
• Citation:
  MMWR 2016 Jul; 65(27):698-699
• Contact Point Address:
  Prakash R. Mulay, Florida Department of Health
• Email:
  Prakash.Mulay@flhealth.gov
• CAS Registry Number:
  Sulfonyl fluoride (CAS RN 2699-79-8)
• Federal Fiscal Year:
  2016
• NORA Priority Area:
  Agriculture, Forestry and Fishing ; Services
• Peer Reviewed:
  False
• Collection(s):
  Morbidity and Mortality Weekly Report (MMWR) National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:94e39dba970375878c7094163c1bcc93429730f21ca689dd6ca6495c101db1091d9cc365e5102222519f55908355edb920d4bd29369d4a8f2d95185316a65bcb
• Download URL:
  https://stacks.cdc.gov/view/cdc/183200/cdc_183200_DS1.pdf
• File Type:
  [PDF - 59.10 KB ]