April 26, 2011 by dailybolusoflr
Hydrofluoric acid (HF)
Where exposure typically happens:
· In the petroleum industry to manufacture high-octane gasoline
· In the production of microelectronics
· For etching glass, removing rust, and cleaning cement and bricks
Typical routes of absorption are from the exposure to the lung, skin, and eyes. Exposure through the skin is the most common.
Mechanism of action:
· HF is a strong acid- it causes a coagulative necrosis
· Most of the complications are related to the free fluoride ion
o Free fluoride ion scavenges cations, such as calcium and magnesium
o Systemic hypocalcemia and hypomagnesemia can result
o Ions can inhibit Na/K ATPase and can lead to hyperkalemia (this is a combination of Na/K ATPase as well as the tissue necrosis).
· Irrigation with copious amounts of water for at least 15 to 30 minutes
· Pain should not persist past irrigation unless a more severe burn is present.
· Blisters should be unroofed and irrigated, as necrotic tissue may contain fluoride ions.
· The fluoride ions ultimately need to be detoxified through treatment with calcium.
o Calcium gluconate gel can be applied for superficial burns
o Calcium gluconate can be injected subcutaneously or intra-arterial injecton for more serious burns.
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions