Hydrofluoric acid: Difference between revisions
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==Background== | ==Background== | ||
* | *Used in both commercial and home setting | ||
**Glass etching, metal cleaning, petroleum processing | **Rust remover (most common home use) | ||
**Glass etching, chrome and other metal cleaning, petroleum processing | |||
*Oral ingestion has very high mortality rate | *Oral ingestion has very high mortality rate | ||
== | ==Clinical Features== | ||
*Onset of symptoms | *Onset and severity of symptoms correlated w/ concentration | ||
**Dilute solutions (<20%) may have delayed onset up to 24hr post-exposure | **Dilute solutions (<20%) may have delayed onset up to 24hr post-exposure | ||
**Moderate solutions (20-50%) develop symptoms w/in 1-8hr | **Moderate solutions (20-50%) develop symptoms w/in 1-8hr | ||
**Concentrated solutions (>50%) develop symptoms immediately | **Concentrated solutions (>50%) develop symptoms immediately | ||
***These pts are at risk for systemic toxicity/death | ***These pts are at highest risk for systemic toxicity/death | ||
***Pain immediately (even if wound appears minor) implies severe injury | ***Pain immediately (even if wound appears minor) implies severe injury | ||
*Burn itself is usually relatively minor | |||
*Toxicity caused by binding of calcium | |||
==Diagnosis and Work-up== | |||
*Trend calcium and potassium levels | *Trend calcium and potassium levels | ||
**HF acid chelates calcium and poisons the Na+/K+ pump | **HF acid chelates calcium and poisons the Na+/K+ pump | ||
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[[Caustics]] | [[Caustics]] | ||
== | ==References== | ||
<references/> | |||
Tintinalli | Tintinalli | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 05:42, 21 June 2015
Background
- Used in both commercial and home setting
- Rust remover (most common home use)
- Glass etching, chrome and other metal cleaning, petroleum processing
- Oral ingestion has very high mortality rate
Clinical Features
- Onset and severity of symptoms correlated w/ concentration
- Dilute solutions (<20%) may have delayed onset up to 24hr post-exposure
- Moderate solutions (20-50%) develop symptoms w/in 1-8hr
- Concentrated solutions (>50%) develop symptoms immediately
- These pts are at highest risk for systemic toxicity/death
- Pain immediately (even if wound appears minor) implies severe injury
- Burn itself is usually relatively minor
- Toxicity caused by binding of calcium
Diagnosis and Work-up
- Trend calcium and potassium levels
- HF acid chelates calcium and poisons the Na+/K+ pump
- Order serial chemistries, EKGs
Treatment
- Minor injuries (<50 cm2 from dilute solutions <20%)
- Copious irrigation
- Application of gel paste of Ca gluconate or benzalkonium Cl
- Rub into affected area for 10-15min w/ pain relief being used as end-point of tx
- Calcium gel is commercially available (found in industrial first-aid kits)
- Calcium gel can be made:
- Mix calcium gluconate powder 3.5gm w/ 150mL water-soluble lubricant OR
- Mix 25mL 10% calcium gluconate solution w/ 75mL water-soluble lubricant
- Benzalkonium Cl is commercially available
- If calcium gluconate is not available calcium chloride can be used
- Severe injuries
- Treat w/ intradermal injections of 5% calcium gluconate
- Prepare by diluting conventional 10% Ca gluconate w/ sterile NS in 1:1 ratio
- Inject in and around the burned area in amount not to exceed 0.5mL per cm2
- Refractory injuries
- Treat w/ intra-arterial infusion of calcium gluconate
- Deliver via arterial line placed proximal to injury in the same limb
- Infuse 10mL of 10% Ca gluconate dilued in 40mL of NS or D5water over 4 hr
- Ingestion
- If <1hr of ingestion place NG tube, suction, gastric lavage
- Follow lavage by 300mL 10% Ca gluconate down NGT
- Provide aggressive IV supplementation if ECG signs of hypoCa or hyperK
- Treat medically as needed
See Also
References
Tintinalli