UMEM Educational Pearls

Title: Hydrofluoric Acid Burns

Keywords: hydrofluoric acid, burn, chemical burn, HFA, calcium gluconate (PubMed Search)

Posted: 9/5/2010 by Dan Lemkin, MS, MD (Updated: 10/2/2010)
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Hydrofluoric acid is a weak acid used primarily in industrial applications for glass etching and metal cleaning/plating. It is contained in home rust removers. Although technically a weak acid, it is very dangerous and burns can be subtle in appearance while having severe consequences.

Wilkes G. Hydrofluoric Acid Burns. Jan 28, 2010.
http://emedicine.medscape.com/article/773304-overview

2 mechanisms that cause tissue damage*
- corrosive burn from the free hydrogen ions
- chemical burn from tissue penetration of the fluoride ions
Clinical features*
- Cutaneous burns - absent findings to white-blue appearance
- Pulmonary edema
- Hypocalcemia, hyperkalemia, hypomagnesemia
Treatment*
- Decontaminate by irrigation with copious amounts of water.
- With any evidence of hypocalcemia, immediately administer 10% calcium gluconate IV.
- Cutaneous burns:
  - Apply 2.5% calcium gluconate gel to the affected area. If the proprietary gel is not available, constitute by dissolving 10% calcium gluconate solution in 3 times the volume of a water-soluble lubricant (eg, KY gel). For burns to the fingers, retain gel in a latex glove.
  - If pain persists for more than 30 minutes after application of calcium gluconate gel, further treatment is required. Subcutaneous infiltration of calcium gluconate is recommended at a dose of 0.5 mL of a 5% solution per square centimeter of surface burn extending 0.5 cm beyond the margin of involved tissue (10% calcium gluconate solution can be irritating to the tissue).
    - Do not use the chloride salt because it is an irritant and may cause tissue damage.

*Extracted from emedicine article.

References

Wilkes G. Hydrofluoric Acid Burns. Jan 28, 2010.
http://emedicine.medscape.com/article/773304-overview