Hydrofluoric acid: Difference between revisions
(Created page with "===Hydrofluoric Acid=== ====Background==== *Uses **Glass etching, metal cleaning, petroleum processing **Found in chrome wheel cleaner, rust remover *Kills via calcium chelation/...") |
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==Background== | |||
*Uses | *Uses | ||
**Glass etching, metal cleaning, petroleum processing | **Glass etching, metal cleaning, petroleum processing | ||
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*Kills via calcium chelation/cardiac arrest, not via burn | *Kills via calcium chelation/cardiac arrest, not via burn | ||
*Oral ingestion has very high mortality rate | *Oral ingestion has very high mortality rate | ||
==Diagnosis== | |||
*Onset of symptoms (pain, erythema) correlated w/ concentration | *Onset of symptoms (pain, erythema) 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 | ||
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*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 | ||
==Treatment== | |||
*Minor injuries (<50 cm2 from dilute solutions <20%) | *Minor injuries (<50 cm2 from dilute solutions <20%) | ||
#Copious irrigation | #Copious irrigation | ||
Revision as of 18:31, 26 July 2011
Background
- Uses
- Glass etching, metal cleaning, petroleum processing
- Found in chrome wheel cleaner, rust remover
- Kills via calcium chelation/cardiac arrest, not via burn
- Oral ingestion has very high mortality rate
Diagnosis
- Onset of symptoms (pain, erythema) 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 risk for systemic toxicity/death
- Pain immediately (even if wound appears minor) implies severe injury
- Trend calcium and potassium levels
- HF acid chelates calcium and poisons the Na+/K+ pump
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