Hydrofluoric acid burns in the western Zhejiang Province of China: a 10-year epidemiological study

Abstract

BackgroundChemical burns caused by hydrofluoric acid (HF) frequently occur in the Western Zhejiang Province. This study aimed to investigate the epidemiological characteristics of HF burns within this region.MethodsA 10-year retrospective analysis was conducted using data from all inpatients with HF burns. These patients were treated at the Department of Burns and Plastic Surgery at our hospital between January 2004 and December 2013. Information obtained for each patient included sex, age, occupation, burn location, burn cause, and the hazard category of the chemical which caused the burn. Data regarding wound site and size, accompanying injuries, serum electrolyte levels, operations, length of hospital stay, and mortality were also assessed.ResultsA total of 201 patients (189 males, 12 females; average age: 38.33 ± 10.57 years) were admitted due to HF burns. Over the 10-year period, the morbidity of HF burns in the past 10 years showed a gradual increase, which paralleled the development of local fluoride industries. Most HF injuries were work related and distributed in working-age patients. Aqueous HF solutions, especially highly concentrated ones, were the most common chemical cause of HF burns. Moreover, inappropriate operation, machine problems, and inadequate protection were identified as the leading causes of HF burns in the workplace. The burn area was <5% of TBSA in more than 90% of patients, and the most common burn sites were the head, neck, and upper extremities. Approximately 17% of patients underwent surgical operation. Accompanying injuries should be detected and treated correctly in a timely manner. Lastly, electrolyte imbalances, such as hypocalcaemia, hypomagnesaemia, and hypokalaemia, occurred frequently in patients with HF exposure; however, hyperkalaemia was not encountered in this study.ConclusionBased on the epidemiological results for HF burns in this region, the related enterprises and local authorities should be encouraged to upgrade management policies and to provide necessary occupational hazard education and safety training for high-risk occupations within high-risk working populations. Furthermore, the enhancement of hazardous chemicals management is also needed. Finally, for patients with HF exposure, early and correct pre-hospital triage, treatment and consequent in-hospital treatment and procedures should also be improved.

Hydrofluoric Acid: Burns and Systemic Toxicity, Protective Measures, Immediate and Hospital Medical Treatment

“…A 10-year [ 1 ], a 11-year [ 20 ], a 15-year [ 30 ], a 20-year [ 2 ] and a 22-year [ 29 ] retrospective epidemiological studies revealed that chemical burns encountered in a Burn centres caused by hydrofluoric acid are one with the most frequent occurrence, especially in the regions with highly developed industry. The most common sites of injury are the head and neck, hands, legs and arms [ 1 ], [ 45 ]. HF burns might be accompanied by ocular injuries, respiratory and digestive tract disorders [ 1 ].…”

“…The most common sites of injury are the head and neck, hands, legs and arms [ 1 ], [ 45 ]. HF burns might be accompanied by ocular injuries, respiratory and digestive tract disorders [ 1 ].…”

“…Symptoms from respiratory system may occur when exposed to HF gas, fumes or vapours which arise when liquid acid evaporates on increased ambient temperature; in the case of a pulmonary aspiration while ingesting [ 1 ]; as a systemic toxicity symptom after HF acid ingestion [ 16 ], [ 18 ]; as a respiratory complication after HF splashes on the skin [ 24 ], or after severe dermal burns [ 45 ].…”

“…Hydrofluoric acid as a chemical compound with a high reactivity is used in many industrial branches: fluorine industry, glass industry, stevedoring and transportation industries, semiconductor industry, stainless steel and aluminum manufacturing, electronic components manufacturing, metal finishing and metal rust removal industry, inorganic and organic chemical manufacturing, mineral processing, petroleum refining, fire extinguishers manufacturing, as well as waste and disposable service sectors [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]. In the dental industry and every-day clinical practice, HF acid is used as an etchant agent for ceramic materials [ 6 ], [ 7 ], [ 8 ].…”

“…Unintentional exposure to hydrofluoric acid or gases, with health consequences, may occur in case of inappropriate operation, inadequate protection, when having machine problems, explosion of HF containers and tanks, during the traffic accidents [ 1 ], and inattentive usage of household agents [ 10 ], while intentionally, in case of suicide [ 11 ], [ 12 ], [ 14 ] and murder. There are cases of intoxicated children when domestic cleaners, in appropriately stored, were accidentally ingested [ 13 ].…”