Hydrofluoric acid

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Hydrofluoric acid

  1. 1. Hydrofluoric Acid พันโท ฐิติศักดิ์ กิจทวีสิน พบ ., วว .( อายุรศาสตร์ ) วว .( อายุรศาสตร์โรคไต ), อว .( อายุรศาสตร์เวชเภสัชวิทยาและพิษวิทยา ) กองอายุรกรรม โรงพยาบาลพระมงกุฎเกล้า
  2. 2. HF <ul><li>Hydrofluoric acid </li></ul><ul><li>Hydrofluoride </li></ul><ul><li>Hydrogen fluoride </li></ul><ul><li>Fluoric acid </li></ul><ul><li>Fluorine monohydride </li></ul>
  3. 3. Hydrogen fluoride <ul><li>Colorless, fuming liquid or gas </li></ul><ul><li>Strong irritating odor </li></ul><ul><li>Dissolves in water  Hydrofluoric acid </li></ul><ul><li>Visibly indistinguishable from water </li></ul>
  4. 4. Sources <ul><li>Glass etching </li></ul><ul><li>Metal cleaning </li></ul><ul><li>Electronic manufacturing </li></ul><ul><li>Rust remover </li></ul><ul><li>กรดกัดแก้ว </li></ul><ul><li>กรดกัดกระจก </li></ul><ul><li>น้ำยากัดกระจก </li></ul><ul><li>น้ำยากัดสนิม </li></ul>
  5. 5. Route of Exposure <ul><li>Inhalation </li></ul><ul><li>Skin contact </li></ul><ul><li>Eye contact </li></ul><ul><li>Ingestion </li></ul>
  6. 6. Health Effects <ul><li>Local corrosive injury </li></ul><ul><li>Systemic fluoride poisoning </li></ul>
  7. 7. Pathophysiology <ul><li>Liberated H +  liquefactive necrosis of skin, mucosa and systemic acidosis </li></ul><ul><li>Fluoride ( F - ) binds tissue Ca ++ and Mg ++ </li></ul><ul><ul><li>Forming insoluble salts  pain, hypoCa ++ , hypoMg ++ </li></ul></ul><ul><ul><li>F - disrupts Na/K-ATPase and K channel  hyperkalemia </li></ul></ul>
  8. 8. Clinical Presentation <ul><li>Dermal exposure </li></ul><ul><ul><li>Pain out of proportion to examination </li></ul></ul><ul><ul><ul><li>Erythema, edema, whitish-blue discoloration </li></ul></ul></ul><ul><ul><li>Exposure to diluted HF </li></ul></ul><ul><ul><ul><li>S/S may be delayed up to 24 hrs </li></ul></ul></ul><ul><ul><li>Lesions : blister, eschar, firm white areas </li></ul></ul>
  9. 9. Onset of Symptoms <ul><li>Time of exposure to onset of symptoms </li></ul><ul><ul><li>Solution of less than 7% several hours </li></ul></ul><ul><ul><li>Solution of 12% up to 1 hour </li></ul></ul><ul><ul><li>Solution > 14.5% immediately </li></ul></ul>
  10. 10. Physical <ul><li>Grade 1 </li></ul><ul><ul><li>White burn mark +/- erythema </li></ul></ul><ul><ul><li>Pain </li></ul></ul><ul><li>Grade 2 </li></ul><ul><ul><li>White burn mark +/- erythema </li></ul></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>Blistering </li></ul></ul><ul><li>Grade 3 </li></ul><ul><ul><li>White burn mark +/- erythema </li></ul></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>Blistering </li></ul></ul><ul><ul><li>Necrosis </li></ul></ul>
  11. 11. Clinical Presentation <ul><li>Inhalation </li></ul><ul><ul><li>Inhaled HF initially affects nose, throat, eyes </li></ul></ul><ul><ul><li>Mucous membrane irritation, cough, choking </li></ul></ul><ul><ul><li>Airway obstruction </li></ul></ul><ul><ul><li>Lung injury may be delayed 12-36 hrs </li></ul></ul>
  12. 12. Clinical Presentation <ul><li>Ingestion </li></ul><ul><ul><li>Intentional ingestion of large volume </li></ul></ul><ul><ul><ul><li>Abdominal pain, vomiting, UGIH </li></ul></ul></ul><ul><ul><li>Potential absence of GI symptoms with dilute ingestion </li></ul></ul><ul><ul><li>Systemic poisoning may occurs within 1-4 hrs </li></ul></ul>
  13. 13. Clinical Presentation <ul><li>Systemic toxicity </li></ul><ul><ul><li>Massive exposure to conc. HF...syncope,death </li></ul></ul><ul><ul><li>May be delayed up to 4 hrs after ingestion of diluted or dermal exposures to conc. HF </li></ul></ul><ul><ul><li>Hypocalcemia, coma, seizure, shock, VT,VF </li></ul></ul><ul><ul><li>Fatalities </li></ul></ul><ul><ul><ul><li>Severe hypocalcemia </li></ul></ul></ul><ul><ul><ul><li>Hypomagnesemia </li></ul></ul></ul><ul><ul><ul><li>Hyperkalemia </li></ul></ul></ul><ul><ul><ul><li>Acute pulmonary injury </li></ul></ul></ul>
  14. 14. Treatment
  15. 15. Pre-hospital Care <ul><li>Assess and manage acute life-threatening conditions </li></ul><ul><li>Remove soiled clothing </li></ul><ul><li>Decontaminated with water irrigation </li></ul><ul><li>Ice pack on affected area </li></ul><ul><li>Calcium gluconate gel </li></ul><ul><li>Mg containing antacid </li></ul><ul><li>Latex glove and iced water immersion </li></ul>
  16. 16. Emergency Department Care <ul><li>Initial care </li></ul><ul><li>Treatment of burn or inhalation exposure </li></ul><ul><li>Treatment of systemic poisoning </li></ul>
  17. 17. Initial cares <ul><li>ABC </li></ul><ul><li>Remove soiled clothing </li></ul><ul><li>Decontamination *** </li></ul><ul><li>Assess & manage life-threatening conditions </li></ul><ul><li>Comprehensive monitor </li></ul><ul><li>Hypocalcemia  calcium gluconate IV </li></ul><ul><ul><li>Bolus 10% Calcium gluconate 0.2 mL/kg </li></ul></ul><ul><li>Empiric IV calcium added to iv. fluid </li></ul><ul><ul><li>10% Ca-gluconate 20mL in 1L of crystalloid > 1 hr </li></ul></ul>
  18. 18. Treatment of Burns <ul><li>2.5% calcium gluconate gel </li></ul><ul><ul><li>10% calcium gluconate 10 mL </li></ul></ul><ul><ul><li>Diluted with K-Y jelly or water 30 mL (1:3) </li></ul></ul><ul><li>Subcutaneous infiltration </li></ul><ul><ul><li>10% calcium gluconate 0.5 mL per sq.cm. </li></ul></ul><ul><li>Do not inject calcium chloride to treat skin burns </li></ul>
  19. 19. Treatment of Burns <ul><li>IV regional </li></ul><ul><ul><li>10% calcium gluconate 10 mL plus heparin 5000 U </li></ul></ul><ul><ul><li>Diluted in 5% dextrose 40 mL </li></ul></ul><ul><ul><li>Use Bier ischemic arm block technique </li></ul></ul><ul><li>Intra-arterial </li></ul><ul><ul><li>10% calcium gluconate 10 mL diluted in 5% dextrose 40 mL </li></ul></ul><ul><ul><li>Infuse over 4 hours in radial or brachial artery via arteial catheter </li></ul></ul><ul><li>Digital block with local anesthesia </li></ul>
  20. 20. Treatment of Inhalation Exposure <ul><li>Oxygen 100% by mask </li></ul><ul><li>Calcium gluconate 2.5% nebulizer </li></ul><ul><ul><li>10% calcium gluconate 25 mL </li></ul></ul><ul><ul><li>Diluted to 100 mL with water </li></ul></ul><ul><li>Pulse oximetry monitoring </li></ul><ul><li>Observe at least 24 hours </li></ul>
  21. 21. Treatment of Systemic Poisoning <ul><li>Hypocalcemia </li></ul><ul><li>Hyperkalemia </li></ul><ul><li>Hypomagnesemia </li></ul>
  22. 22. THANK YOU FOR YOUR ATTENTION

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