Advice to a Doctor for Dealing with Hydroflouric Acid Burns and Exposure

Hydrogen fluoride in aqueous solution is usually referred to as hydrofluoric acid

The damage caused by exposure to this product is far more extensive than that caused by hydrochloric acid and other acids. First aid and medical treatment appropriate to hydrochloric acid is not beneficial with hydrofluoric acid burns. Hydrofluoric acid penetrates rapidly and deeply below fat layers binding and depleting tissue calcium. Failure to commence the correct medical treatment promptly may be fatal.

There is a major risk of systemic toxicity following inhalation, ingestion or skin burns. Calcium depletion (hyperkalaemia) and electrolyte disorders may be fatal. A skin burn involving more than 1 % of body area with 50 % or more concentration of hydrofluoric acid or more than 5 % of body area with any lesser concentrations may be associated with systemic effects. Treatment with intravenous calcium gluconate should commence immediately.

Intensive care unit facilities are likely to be needed. Serum calcium and magnesium determinations should be performed frequently and correction of electrolyte balance may be necessary. ECGs should be monitored routinely for prolonged Q- T interval or bradycardia. Hepatic and renal function should be monitored. IV corticosteroids may be necessary.

Inhalation may lead to chemical pneumonitis, haemorrhagic pulmonary oedema or laryngeal oedema and may be fatal. Be prepared to intubate or perform a tracheotomy. The use of nebulised calcium gluconate in a 2.5 % solution should be considered.

Skin burns may become necrotic and gangrenous and damaged area may spread. Infiltration of calcium gluconate into the surrounding tissue may be required for severe burns; this can be performed by the injection of 5 % calcium gluconate solution. Injection should be performed with care on the hands, feet and face.

For fingers and toes and less severe burns, continue the application of 2.5 % calcium gluconate gel four to six times daily for up to three to four days. Wear gloves while applying gel. If calcium gluconate solution is injected into the fingers or toes great care should be exercised and no more than 0.5 ml should be used. Pain not relieved by use of gel is best managed by intra-arterial infusion of calcium gluconate solution in a unit that is experienced in the technique. Surgical debridement of affected area may be necessary in larger burns to control hypocalcaemia. Delayed pulmonary oedema is likely with burns to the face or neck. Local anaesthesia is contra-indicated, so that the splitting of finger and toe nails should be performed under general anaesthesia.

Following contact of this product with the eyes, ensure first aid treatment has been carried out. Instil 1 % calcium gluconate solution every two to three hours for as long as considered necessary. Topical anaesthetic and corticosteroid drops may be useful. An ophthalmologist should always be consulted, as severe corneal damage is possible. Long term monitoring may be necessary.

Further information about the treatment of hydrofluoric acid burns can be obtained from the National Poisons Information Centre on 13 1126.

Reference

modified extract from Plastics and Chemicals Industries Association, Hydrofluoric acid, Code of Practice, June 1997.

For further information contact:
OHS Officer, e-mail: OHS.Officer@anu.edu.au