Hydrofluoric acid is a colorless, fuming liquid or gas that is used for glass etching, metal cleaning, and rust removal. Exposure can occur through inhalation, skin contact, eye contact, or ingestion. It causes local corrosive injury and can lead to systemic fluoride poisoning. Fluoride binds to tissue calcium and magnesium ions, causing pain, hypocalcemia, and hypomagnesemia. Treatment involves removal of contaminated clothing, decontamination, calcium gluconate for skin or eye exposure and systemic poisoning, and monitoring for hypocalcemia, hyperkalemia, and hypomagnesemia.

1. Hydrofluoric Acid พันโท ฐิติศักดิ์ กิจทวีสิน พบ ., วว .( อายุรศาสตร์ ) วว .( อายุรศาสตร์โรคไต ), อว .( อายุรศาสตร์เวชเภสัชวิทยาและพิษวิทยา ) กองอายุรกรรม โรงพยาบาลพระมงกุฎเกล้า

2. HF Hydrofluoric acid Hydrofluoride Hydrogen fluoride Fluoric acid Fluorine monohydride

3. Hydrogen fluoride Colorless, fuming liquid or gas Strong irritating odor Dissolves in water  Hydrofluoric acid Visibly indistinguishable from water

4. Sources Glass etching Metal cleaning Electronic manufacturing Rust remover กรดกัดแก้ว กรดกัดกระจก น้ำยากัดกระจก น้ำยากัดสนิม

5. Route of Exposure Inhalation Skin contact Eye contact Ingestion

6. Health Effects Local corrosive injury Systemic fluoride poisoning

7. Pathophysiology Liberated H +  liquefactive necrosis of skin, mucosa and systemic acidosis Fluoride ( F - ) binds tissue Ca ++ and Mg ++ Forming insoluble salts  pain, hypoCa ++ , hypoMg ++ F - disrupts Na/K-ATPase and K channel  hyperkalemia

8. Clinical Presentation Dermal exposure Pain out of proportion to examination Erythema, edema, whitish-blue discoloration Exposure to diluted HF S/S may be delayed up to 24 hrs Lesions : blister, eschar, firm white areas

9. Onset of Symptoms Time of exposure to onset of symptoms Solution of less than 7% several hours Solution of 12% up to 1 hour Solution > 14.5% immediately

10. Physical Grade 1 White burn mark +/- erythema Pain Grade 2 White burn mark +/- erythema Pain Edema Blistering Grade 3 White burn mark +/- erythema Pain Edema Blistering Necrosis

11. Clinical Presentation Inhalation Inhaled HF initially affects nose, throat, eyes Mucous membrane irritation, cough, choking Airway obstruction Lung injury may be delayed 12-36 hrs

12. Clinical Presentation Ingestion Intentional ingestion of large volume Abdominal pain, vomiting, UGIH Potential absence of GI symptoms with dilute ingestion Systemic poisoning may occurs within 1-4 hrs

13. Clinical Presentation Systemic toxicity Massive exposure to conc. HF...syncope,death May be delayed up to 4 hrs after ingestion of diluted or dermal exposures to conc. HF Hypocalcemia, coma, seizure, shock, VT,VF Fatalities Severe hypocalcemia Hypomagnesemia Hyperkalemia Acute pulmonary injury

14. Treatment

15. Pre-hospital Care Assess and manage acute life-threatening conditions Remove soiled clothing Decontaminated with water irrigation Ice pack on affected area Calcium gluconate gel Mg containing antacid Latex glove and iced water immersion

16. Emergency Department Care Initial care Treatment of burn or inhalation exposure Treatment of systemic poisoning

17. Initial cares ABC Remove soiled clothing Decontamination *** Assess & manage life-threatening conditions Comprehensive monitor Hypocalcemia  calcium gluconate IV Bolus 10% Calcium gluconate 0.2 mL/kg Empiric IV calcium added to iv. fluid 10% Ca-gluconate 20mL in 1L of crystalloid > 1 hr

18. Treatment of Burns 2.5% calcium gluconate gel 10% calcium gluconate 10 mL Diluted with K-Y jelly or water 30 mL (1:3) Subcutaneous infiltration 10% calcium gluconate 0.5 mL per sq.cm. Do not inject calcium chloride to treat skin burns

19. Treatment of Burns IV regional 10% calcium gluconate 10 mL plus heparin 5000 U Diluted in 5% dextrose 40 mL Use Bier ischemic arm block technique Intra-arterial 10% calcium gluconate 10 mL diluted in 5% dextrose 40 mL Infuse over 4 hours in radial or brachial artery via arteial catheter Digital block with local anesthesia

20. Treatment of Inhalation Exposure Oxygen 100% by mask Calcium gluconate 2.5% nebulizer 10% calcium gluconate 25 mL Diluted to 100 mL with water Pulse oximetry monitoring Observe at least 24 hours

21. Treatment of Systemic Poisoning Hypocalcemia Hyperkalemia Hypomagnesemia

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