Hydrofluoric acid

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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
  • Onset and severity of symptoms correlated with concentration
    • Dilute solutions (<20%) may have delayed onset up to 24hr post-exposure
    • Moderate solutions (20-50%) develop symptoms within 1-8hr
    • Concentrated solutions (>50%) develop symptoms immediately
      • These patients are at highest risk for systemic toxicity/death
      • Pain immediately (even if wound appears minor) implies severe injury
  • Burn itself may appear relatively minor
  • Toxicity caused by binding of calcium

Clinical Features

Hydrofluoric acid burn

Differential Diagnosis

Caustic Burns

Evaluation

  • Clinical diagnosis
  • Trend calcium, magnesium, and potassium levels
  • Monitor EKG for signs of electrolyte abnormality

Management

  • Decontamination: remove soiled clothing and irrigate thoroughly.
  • Mainstay of treatment is application of calcium to affected area.

Cutaneous Burns

Minor injuries (<50 cm2 from dilute solutions <20%)

  • Application of gel paste of Ca gluconate or benzalkonium Cl
    • Rub into affected area for 10-15min with pain relief being used as end-point of treatment
    • Calcium gel is commercially available (found in industrial first-aid kits)
    • Calcium gel can be made:
      • Mix calcium gluconate powder 3.5gm with 150mL water-soluble lubricant OR
      • Mix 25mL 10% calcium gluconate solution with 75mL water-soluble lubricant
    • Benzalkonium Cl is commercially available
    • If calcium gluconate is not available calcium chloride can be used

Severe injuries

  • Treat with intradermal injections of 5% calcium gluconate
    • Prepare by diluting conventional 10% Ca gluconate with 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 with 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

Ocular burns

  • Irrigate with saline for at least 5 min
  • If persistent pain administer 1% calcium gluconate to eye (dilute 10% calcium gluconate with normal saline)
    • Consult ophthalmology due to irritation effect of calcium salts to eye

Ingestion

  • If <1hr of ingestion, may consider NG tube for suction and gastric lavage
    • Follow lavage by 300mL 10% Ca gluconate down NGT
  • Consider intubation for airway protection

Inhalation

  • Oxygen via NRB
  • Nebulized 2.5% calcium gluconate

Systemic toxicity

Disposition

  • Consultation with poison center and burn center transfer per Burn center criteria
  • Admission for all patients with arrhythmia on ECG or severe electrolyte disturbance

See Also

References