An algorithmic approach to the treatment of hydrofluoric acid burns

A review of hydrofluoric acid burn management

“…Both describe the patient populations at risk for systemic toxicity as being any burns with >50% concentration, exposure of >5% total body surface area (TBSA) with any HF concentration, and inhalation or ingestion of HF (7,8). However, these guidelines have had rare exceptions Hydrofluoric acid (HF) causes a unique chemical burn.…”

“…For severe HF burns, serum electrolyte levels should be obtained urgently and then frequently monitored as dictated by the degree of clinical exposure and systemic involvement. Guidelines advocate calcium replacement in high-risk groups even before the serum calcium level is determined (8). Proven hypocalcemia warrants calcium gluconate infusion parenterally and frequent serum calcium monitoring.…”

“…Calcium gluconate gel is standard practice to treat HF burns in most centres despite there being no controlled studies involving humans showing any benefit or to guide protocol. Calcium gluconate gel can be made in the emergency department with a water-soluble lubricant, such as K-Y Jelly (Johnson & Johnson, USA), added to calcium gluconate solution or calcium gluconate powder (75 mL K-Y Jelly plus 25 mL of 10% calcium gluconate or 100 mL of K-Y Jelly plus 2.5 g of calcium gluconate) (8,18). The gel is applied every 30 min initially and massaged in, then applied every 4 h. A clinically reliable indicator of effectiveness is pain relief (19,20).…”

Intoxicación por ácido fluorhídrico. Presentación de un caso clínico

“…4,12 La administración de sales de calcio por vía oral, especialmente cuando hay lesiones del esó-fago (gluconato de calcio, carbonato de calcio o leche) y los antiácidos a base de magnesio o aluminio son útiles, pues forman complejos insolubles con el flúor que posteriormente se excretan con las heces, lo cual reduce su absorción. 6,7,11 Se debe considerar la aspiración gástrica cuidadosa o el lavado gástrico con una sonda nasogástrica pequeña (18 Fr), colocada bajo visión endoscópica, en los pacientes con ingestiones significativas que se presentan en el plazo de 60 minutos de la exposición y no han vomitado espontáneamente.…”

Damaged Skin

“…Using water immediately allows dragging and diluting and dragging a major part of HF from the skin surface. But obviously, water, alone, is not always efficient, especially for concentrated HF and/or large surface skin exposure even if washing being prolonged at least 15-30 min or more [232].…”