Hydrofluoric Acid Burns

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Hydrofluoric Acid Burns can be very serious burns, with fatalities documented at <5% burns area.

Hydrofluoric acid is a weak acid that is used in industry in electroplating and glass etching and in smaller business in carpet cleaners and other such stain removing products. It’s a weak acid with good tissue penetration, that binds calcium and magnesium. Presentation is almost always with severe pain. The higher the concentration the earlier the pain presents itself. For example concentrations of >50% will have pain almost instantly, whereas concentrations <20% will have significant delayed pain of several hours. Pain relief is our gauge of effectiveness of treatment and as such, local anaesthetics should not be used. Treatments vary depending on the degree of exposure.

TREATMENT

Irrigate for 15 minutes.

1 Ca gluconate gel

2 Local infiltration

0.5ml/cm2 with 10% Calcium gluconate – only in small localised exposures. DO NOT USE Ca Cl as it may cause tissue necrosis. For perfusion requirements, the textbooks say the following:

3 IV Regional perfusion:

best for forearm and hand, not as good for fingers. Release torniquet in 20 minutes or earlier of pain relieved.

a.Biers block: Inject with

i.10ml Ca gluconate 10%

ii.40ml 5% dext

iii.heparin 5000U

4 Intra-arterial regional perfusion:

best for finger or more extensive burns. 2-3 infusions may be required.

a.Radial artery catheter

b.Brachial artery catheter if ring or 5th finger involved.

c.Infuse via pump, chech patency every 30 minutes. Infuse over 4 hours

i.Ca gluconate 10% 15-20 mls to 50ml NSaline or 200ml dext 5%

Beware as this is a very specialised area, and something you may not treat very often. Before you give any of the intravenous treatments you need to consult with a toxicologist.

Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator resus.com.au.

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