A construction worker presents after spilling industrial cleaner on his hand while cleaning a brick building:
What possible chemical exposure should you be concerned about? What is the treatment?
HYDROFLUORIC ACID BURN
- Most commonly used in glass etching, and for cleaning brick/porcelain.
- May initially be pain-free but can cause tremendous pain out of proportion to burn appearance
- Systemic toxicity: HYPERkalemia, HYPOmagnesemia, HYPOcalcemia, can lead to cardiac arrest
- Death reported after just 2-3% body surface area exposure!
- Skin decontamination (remove clothes, copiously irrigate)
- Correct electrolyte abnormalities
- Topical calcium gluconate gel: will sequester fluoride ions to prevent further toxicity, may help to correct hypocalcemia
- **If commercial calcium gel is not available, mix 3.5 g calcium gluconate powder with 140 g (5 oz) of water soluble surgical lubricant.
Kaushik and Bird. Topical chemical burns. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2013.
Mayer TG, GrossPI. Fatal systemic fluoride due to hydrofluoric acid burns. Ann Emerg Med 1985; 14: 149-153.