Hydrofluoric acid: Difference between revisions
| Line 24: | Line 24: | ||
==Management== | ==Management== | ||
===Minor injuries (<50 cm2 from dilute solutions <20%)=== | |||
#Copious irrigation | #Copious irrigation | ||
#Application of gel paste of Ca gluconate or benzalkonium Cl | #Application of gel paste of Ca gluconate or benzalkonium Cl | ||
| Line 34: | Line 34: | ||
##Benzalkonium Cl is commercially available | ##Benzalkonium Cl is commercially available | ||
##If calcium gluconate is not available calcium chloride can be used | ##If calcium gluconate is not available calcium chloride can be used | ||
===Severe injuries=== | |||
#Treat w/ intradermal injections of 5% calcium gluconate | #Treat w/ intradermal injections of 5% calcium gluconate | ||
##Prepare by diluting conventional 10% Ca gluconate w/ sterile NS in 1:1 ratio | ##Prepare by diluting conventional 10% Ca gluconate w/ sterile NS in 1:1 ratio | ||
##Inject in and around the burned area in amount not to exceed 0.5mL per cm2 | ##Inject in and around the burned area in amount not to exceed 0.5mL per cm2 | ||
===Refractory injuries=== | |||
#Treat w/ intra-arterial infusion of calcium gluconate | #Treat w/ intra-arterial infusion of calcium gluconate | ||
##Deliver via arterial line placed proximal to injury in the same limb | ##Deliver via arterial line placed proximal to injury in the same limb | ||
##Infuse 10mL of 10% Ca gluconate dilued in 40mL of NS or D5water over 4 hr | ##Infuse 10mL of 10% Ca gluconate dilued in 40mL of NS or D5water over 4 hr | ||
===Ingestion=== | |||
#If <1hr of ingestion place NG tube, suction, gastric lavage | #If <1hr of ingestion place NG tube, suction, gastric lavage | ||
##Follow lavage by 300mL 10% Ca gluconate down NGT | ##Follow lavage by 300mL 10% Ca gluconate down NGT | ||
Revision as of 01:48, 22 June 2015
Background
- Used in both commercial and home setting
- Rust remover (most common home use)
- Glass etching, chrome and other metal cleaning, petroleum processing
- Oral ingestion has very high mortality rate
Clinical Features
- Onset and severity of symptoms correlated w/ concentration
- Dilute solutions (<20%) may have delayed onset up to 24hr post-exposure
- Moderate solutions (20-50%) develop symptoms w/in 1-8hr
- Concentrated solutions (>50%) develop symptoms immediately
- These pts are at highest risk for systemic toxicity/death
- Pain immediately (even if wound appears minor) implies severe injury
- Burn itself is usually relatively minor
- Toxicity caused by binding of calcium
Differential Diagnosis
Caustic Burns
- Caustic ingestion
- Caustic eye exposure (Caustic keratoconjunctivitis)
- Caustic dermal burn
- Airbag-related burns
- Hydrofluoric acid
- Tar burn
- Cement burn
Diagnosis
- Trend calcium and potassium levels
- HF acid chelates calcium and poisons the Na+/K+ pump
- Order serial chemistries, EKGs
Management
Minor injuries (<50 cm2 from dilute solutions <20%)
- Copious irrigation
- Application of gel paste of Ca gluconate or benzalkonium Cl
- Rub into affected area for 10-15min w/ pain relief being used as end-point of tx
- Calcium gel is commercially available (found in industrial first-aid kits)
- Calcium gel can be made:
- Mix calcium gluconate powder 3.5gm w/ 150mL water-soluble lubricant OR
- Mix 25mL 10% calcium gluconate solution w/ 75mL water-soluble lubricant
- Benzalkonium Cl is commercially available
- If calcium gluconate is not available calcium chloride can be used
Severe injuries
- Treat w/ intradermal injections of 5% calcium gluconate
- Prepare by diluting conventional 10% Ca gluconate w/ sterile NS in 1:1 ratio
- Inject in and around the burned area in amount not to exceed 0.5mL per cm2
Refractory injuries
- Treat w/ intra-arterial infusion of calcium gluconate
- Deliver via arterial line placed proximal to injury in the same limb
- Infuse 10mL of 10% Ca gluconate dilued in 40mL of NS or D5water over 4 hr
Ingestion
- If <1hr of ingestion place NG tube, suction, gastric lavage
- Follow lavage by 300mL 10% Ca gluconate down NGT
- Provide aggressive IV supplementation if ECG signs of hypoCa or hyperK
- Treat medically as needed