Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report

Abstract

BACKGROUNDHydrofluoric acid (HF) is one of the most common causes of chemical burns. HF burns can cause wounds that deepen and progress aggressively. As a result, HF burns are often severe even if they involve a small area of the skin. Published cases of HF burns have mostly reported small HF burn areas. Few cases of HF inhalation injury have been reported to date.CASE SUMMARYA 24-year-old man suffered from extensive hydrofluoric acid burns covering 60% of the total body surface area (TBSA), including deep second degree burns on 47% and third degree burns on 13% of the TBSA, after he fell into a pickling pool containing 15% HF. Comprehensive treatments were carried out after the patient was admitted. Ventricular fibrillation occurred 9 times within the first 2 h, and the lowest serum Ca2+ concentration was 0.192 mmol/L. A dose of calcium gluconate (37 g) was intravenously supplied during the first 24 h, and the total amount of calcium gluconate supplementation was 343 g. Extracorporeal membrane oxygenation (ECMO) was applied for 8 d to handle the acute respiratory distress syndrome (ARDS) induced by the HF inhalation injury. The patient was discharged after 99 d of comprehensive treatment, including skin grafting.CONCLUSIONExtensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS. Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.

Extracorporeal Life Support in Adult Burn Care: A Systematic Review

“…Pu et al 34 have reported the combined use of ECMO and CVVH for the successful treatment of a young adult sustaining 60% burn and inhalation injury due to hydrofluoric and nitric acid. Fang et al 35 have reported a young adult requiring ECMO support following severe hydrofluoric acid burn and inhalation injury. Further case reports and case series have been published more recently demonstrating the use of ECMO as a viable option in patients sustaining burn and inhalation injuries.…”

Chemical pneumonitis by prolonged hydrogen fluoride inhalation

“…A small amount of inhaled HF causes irritation only in the upper airway, but a moderate amount may cause chemical pneumonitis, and a large amount appears to cause acute respiratory distress syndrome [ 13 , 14 ]. It appears that inhaled HF acid diffuses into the cells of the tissue and penetrates deeply, combines with calcium to cause electrolytic abnormalities, and gives off toxic effects while circulating throughout the body, causing systemic symptoms [ 8 , 15 ]. It is thought that inflammation of the lung and systemic circulation of HF causes systemic symptoms such as myalgia, chilling, and febrile sensation.…”

“…According to the reported literature, inhalation injuries are mostly caused by unexpected major accidents [ [5] , [6] , [7] ]. In such an accident, the victim inhaled a large amount of gas in a short time; usually, fatal damage occurs [ 8 ]. People around disaster or accident are also exposed to the gas, but they are exposed to low concentrations due to physical distance.…”

Quemadura química por ácido fluorhídrico: mecanismos fisiopatológicos de la lesión

“…21 Una disminución leve puede verse reflejada a este nivel, condicionando alteraciones del ritmo, hasta una disfunción severa que origine la aparición de arritmias letales, reportándose casos de taquicardia ventricular, fibrilación ventricular, daño miocárdico y falla cardiaca congestiva. 22 La traducción electrocardiográfica más común de hipocalcemia es la prolongación del intervalo QT (Figura 5) como resultado del alargamiento del segmento ST, ocasionalmente, la hipocalcemia puede manifestarse con elevación del segmento ST, simulando un evento isquémico a nivel miocárdico. 23 Hipomagnesemia.…”