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The role of calcium gluconate in the treatment of hydrofluoric acid eye burn.

Hydrofluoric acid is used for different purposes in industry and in the home as a rust remover. Most exposures are accidental and may result in severe superficial and deep tissue injury as well as systemic toxicity. There is uncertainty regarding the optimal treatment of hydrofluoric acid eye injury. A patient in whom a solution of 49% hydrofluoric acid induced a large corneal erosion is described. Repeated instillation of 1% calcium gluconate eye drops combined with the conventional treatment of acid eye burns resulted in a complete and quick recovery.

Adult↗

Fatality due to acute hydrofluoric acid exposure.

Although hydrofluoric acid burns are frequent, fatality is rare. In the case of massive exposure, the prognosis is generally poor. We present two fatal cases resulting from extensive exposure to hydrofluoric acid which produced acute systemic metabolic acidosis with profound hypocalcemia and hypomagnesemia. Both patients died within three hours after the exposure. The current knowledge of treatment for severe hydrofluoric acid burns is reviewed and the importance of prevention and prompt recognition for proper treatment is emphasized.

Accidents, Occupational↗

Treatment of digital hydrofluoric acid burns.

BACKGROUND: Hydrofluoric acid (HF) is one of the strongest inorganic acids and is used widely in industry. It differs from other acids in the mechanism of injury. The hydrogen ion readily penetrates the skin and causes destruction of deep tissue layers and even bone. METHODS: If HF burns to the digital skin, keep washing with large amounts of tap water for a minimum of 15 minutes. Then topically apply 2.5% calcium gluconate gel and massage for at least 40 minutes. Locally inject with 10% calcium gluconate solution if the pain persists. We studied the cases with HF finger burns in our hospital. RESULTS: In general, this procedure is effective in the treatment of fingertip hydrofluoric acid burns. In 2 cases, due to attentive treatment, posttreatment conditions were red swelling of the skin only. The posttreatment conditions of the 10 cases have good prognosis. In one case, the worker had very poor sense of first-aid awareness; after her burn was treated with running water, she didn't receive proper treatment immediately. The wound took 20 days to heal. In the last 2 cases, low concentrations of hydrofluoric acid entered the eyes, but after treated with running water, no aftereffects were suffered. CONCLUSIONS: An accurate occupational history and physical examination are important aspects in patient assessment. We hope that this report will assist practitioner to properly manage HF burns.

Adult↗

Clinical and radiographic behaviour of 290 dental implants with a surface treated with hydrofluoric acid and passivated with hydrofluoric and nitric acid: early loading results after 2 years.

OBJECTIVE: This work presents the results of clinical and radiological behaviour, for 2 years, of 290 implants treated with a first etching with HF and a second etching with HF and HNO3 acids and that were loaded 8 weeks after insertion. EXPERIMENTAL DESIGN: It is a prospective study on 290 implants placed in 56 patients with an age range from 28 to 81. The selection was previously made through radiological study with panoramic and tomographic radiographs, followed by the implantological treatment with prosthetic loading and clinical (15 days, 1, 3 , 6, 12, 18 and 24 months) and radiological control (12 and 24 months). RESULTS: During the healing period, 11 implants failed, resulting in a CSR of 96.21%. After prostheses placement at 2 months, 4 implants were retired, successfully remaining 275 implants. CONCLUSIONS: The following and favourable results after the prosthetic loading of 179 implants (CSR of 98.56%), attest that early loading may and must be applied, after rigorous planning and case selection.

Acid Etching, Dental↗

Total body immersion in hydrofluoric acid.

Exposure to hydrofluoric acid is serious and many times fatal. We have reported the case of a man who was totally immersed in a 10% hydrofluoric acid solution. A multidisciplinary approach to management was important to his ultimate recovery.

Burns, Chemical↗

Survival after a massive hydrofluoric acid ingestion.

BACKGROUND: Hydrofluoric acid ingestion is known to have a very high mortality rate secondary to the rapid development of hypocalcemia and fatal arrhythmias. CASE REPORT: A 33-year-old man ingested an estimated dose of hydrofluoric acid 6 times that considered to be lethal. The patient survived with minimal morbidity despite having multiple ventricular fibrillation arrests. His survival is attributed to early, high dose calcium therapy given via the nasogastric and intravenous routes.

Adult↗

Determination of 5-methylcytosine by acid hydrolysis of DNA with hydrofluoric acid.

Quantitation of 5-methylcytosine in DNA after acid hydrolysis has been inaccurate because deamination of cytosine and 5-methylcytosine occurs during the hydrolysis procedure. There is little information in the literature regarding the use of hydrofluoric acid (HF) for DNA hydrolysis and we have therefore undertaken a systematic study of this process. The deoxyribonucleotides of cytosine and 5-methylcytosine were shown not to undergo detectable levels of deamination during prolonged periods (up to 24 h) at 80 degrees C in 48% HF. Kinetic studies show that the release of purine and pyrimidine bases was complete by 4 h under these conditions. Analysis of the 5-methylcytosine content of DNA from various tissues gave levels that were very close to the values reported in the literature. This method is ideally suited for the determination of the overall cytosine methylation levels in DNA.

5-Methylcytosine↗

Calcium carbonate gel therapy for hydrofluoric acid burns of the hand.

Hydrofluoric acid is used extensively as an industrial cleaning agent for metals and glass. Many workers are injured by cutaneous contact of the acid with exposed skin surfaces, particularly hands. Hydrofluoric acid burns are characterized by delayed onset of symptomatology with skin ulceration, and severe pain may be of extended duration. Treatment of hydrofluoric acid burns traditionally has consisted of local infiltration or intraarterial injections of calcium solutions. These injections are painful and frequently require retreatment. A new treatment utilizing a topical gel of calcium carbonate is described. Nine patients have been treated for hydrofluoric acid burns of the hand with calcium carbonate gel applied topically and covered with occlusive glove dressings. A gel slurry is compounded from calcium carbonate tablets and K-Y Jelly. Fingernails of the affected fingers are removed if a subungual burn is obvious. The gel is put into a surgeon's glove and placed over the burned hand. The patient replaces the glove and slurry every 4 hours for 24 hours. After the first day, the glove is discontinued unless there is resumption of painful symptoms. Full range of motion is encouraged during this interval. The calcium carbonate gel technique was successfully utilized in nine patients with no further need for injection therapy. In these patients, pain relief was obtained within 4 hours of treatment, with no further progression of skin ulceration. No reconstructive procedures were required in any patient, and only one patient did not return to full-duty work within 1 week. There were no long-term sequelae from burns treated with this topical therapy, except one patient, who presenting 24 hours after the burn, developed a digital tip neuroma that was excised.

Adult↗

An improved method for emergent decontamination of ocular and dermal hydrofluoric acid splashes.

Accidental hydrofluoric acid (HF) splashes often occur in industrial settings. HF easily penetrates into tissues by initial acid action allowing fluoride ions to penetrate deeply, chelating calcium and magnesium. Resultant hypocalcemia and hypomagnesemia can be fatal. This report describes the utilization of Hexafluorine--a hypertonic, amphoteric, chelating decontamination solution--in workplaces where water decontamination followed by calcium gluconate inunction failed to prevent HF burns and systemic toxicity. Between 1998 and 1999, 16 cases of ocular and dermal HF splashes with either 70% HF or 6% HF/15% nitric acid (HNO3) were decontaminated with Hexafluorine at the worksite. HF burns did not develop and medical treatment other than initial decontamination was not reQuired in 12/16 (75%). In 7/16 (44%) cases, lost work time corresponded to duration of hospital observation (mean < 1 d).

Adult↗

Hydrofluoric acid burns.

Contact with hydrofluoric acid may produce extensive tissue necrosis. This can be prevented by prompt recognition and specific treatment. Unfortunately, symptoms and therefore treatment are often delayed. Education of employees and physicians should result in the prevention of unnecessary tissue destruction and pain for those inadvertently exposed to hydrofluoric acid.

Accidents, Occupational↗

Recurrent ventricular tachyarrhythmias associated with QT prolongation following hydrofluoric acid burns.

BACKGROUND: Some hydrofluoric acid burns appear initially as only a slight wound, but patients may show dramatic changes within several hours. The extent of such burns are directly related to the concentration, amount, and duration of exposure. CASE REPORT: A 64-year-old man sustained 44% total body surface burns after exposure to 30% hydrofluoric acid. Approximately 5 h after injury, he developed recurrent ventricular tachycardia and ventricular fibrillation which occurred in conjunction with long QT syndrome. In this case, the occurrence of hypocalcemia and especially hypomagnesemia played an important role in the development of long QT syndrome.

Burns, Chemical↗

Cleavage of the O antigen 4, 5, 12 of Salmonella typhimurium by hydrofluoric acid.

The effect of hydrofluoric acid (aqueous 48% HF) upon different lipopolysaccharides (LPS) was studied, employing conditions (48 h at +4 degrees C) that are commonly used to dephosphorylate LPS. From the LPS of Salmonella typhimurium having the O antigen 4,5,12 almost all of the O-antigenic sugars (Abe, Gal, Glc, Man, Rha) were liberated in dialysable form, whereas the saccharide chains of Salmonella LPS with O antigen 6,7 (Man, Glc, GlcNAc) were resistant to HF. The lability towards HF was shown to be due to the presence of the deoxysugar L-rhamnose in the saccharide backbone of the O antigen 4,5,12, since only Rha was found as the terminal sugar in the corresponding dialysable material. Hydrofluoric acid can thus be used to specifically cleave Rha-containing polysaccharides.

Antigens, Bacterial↗

A biochemical and histologic rationale for the treatment of hydrofluoric acid burns with calcium gluconate.

Hydrofluoric acid has unique properties that make it attractive for a variety of industrial and household uses. Exposure to dilute and concentrated solutions of hydrofluoric acid can lead to severe pain and tissue necrosis. Local treatment with topical calcium gluconate and subdermal injections of 0.5 ml 10% solution of calcium gluconate per cm2 of affected tissue has been advocated but frequently fails to relieve the patient of pain. Intraarterial infusion of calcium gluconate has been advocated for these patients, but several reports have been made of massive soft-tissue loss associated with such therapy. The purpose of this study was to show what, if any, were the microscopic effects on the distal arterial tree of intraarterial infusion of calcium gluconate. By studying 1 micron-thick cuts of distal rat aortas after proximal infusion of concentrated (10%) and dilute (2%) calcium gluconate, we were able to show that the incidence of microperforations in the intima and media of the rat aorta increased with the concentration of calcium gluconate. We conclude that intraarterial infusions should be reserved for only the most severe cases of hydrofluoric acid burns unresponsive to local therapy.

Animals↗

Hexafluorine vs. standard decontamination to reduce systemic toxicity after dermal exposure to hydrofluoric acid.

INTRODUCTION: Dermal exposure to hydrofluoric acid (HF) may cause severe burns and systemic toxicity. Hexafluorine (Prevor, France) is a product marketed as an emergency decontamination fluid for HF skin and eye exposures. Documentation concerning Hexafluorine is scanty, and a recent study indicates that its ability to reduce HF burns is at most equal to that of water. OBJECTIVE: The present study was conducted to evaluate Hexafluorine's capacity to reduce HF-induced systemic toxicity. METHODS: Sprague Dawley rats were anesthetized, catheterized in the left femoral artery, and shaved on their back. A filter paper (3.5 x 6 cm) was soaked in 50% HF and applied on the back of each rat for 3 min. Thirty seconds after removal of the paper, a 3-min rinsing with either 500 mL Hexafluorine (group H), 500 mL water (group W), or 500 mL water followed by a single application of 2.5% calcium gluconate gel (group Ca) was carried out. Blood samples were analyzed for ionized calcium and potassium (before injury and 1, 2, 3, and 4 h after) and also for ionized fluoride (1, 2, and 4 h after injury). RESULTS: The animals developed hypocalcemia, hyperkalemia, and hyperfluoridemia after the HF exposure. The only significant difference observed among the groups was in serum potassium at 1 h between group Ca and group W. However, there was a constant trend toward milder hypocalcemia and less pronounced hyperkalemia in group Ca compared to the other groups. There were no differences in the electrolyte disturbances between the Hexafluorine-treated animals and those treated with water only. Five of 39 animals died before completion of the experiment as a result of the HF exposure, one from group Ca and two from each of the other two groups. CONCLUSION: In this experimental study, decontamination with Hexafluorine was not more effective than water rinsing in reducing electrolyte disturbances caused by dermal exposure to hydrofluoric acid.

Animals↗

[General practice-relevant therapeutic recommendations in hydrofluoric acid burns].

Burns caused by exposure to hydrofluoric acid are characterized by severe progressive tissue destruction and excruciating pain resulting from the unique properties of the fluoride ion. The subungual tissues are especially susceptible to the destructive effects of hydrofluoric acid. Therefore, proper treatment of hydrofluoric acid burns requires prompt recognition and the institution of specific therapeutic measures by the attending dermatologist.

Accidents, Occupational↗

[Therapy of hydrofluoric acid burns].

Treatment of hydrofluoric acid burns differs very much from treatment of other acid burns. Incorrect anamnestic data caused a delayed specified therapy on one of our patients, who had a cardiac arrest several hours after the accident. We suggest to control serum-electrolytes frequently in every major acid burn and have a chemist analyse the acid at the site of the accident, even if the anamnestic statements seem "reliable".

Adult↗

Hydrofluoric acid burns: a review.

Hydrofluoric acid (HF) is a highly dangerous substance with a wide range of industrial as well as domestic applications. It is unique in both the severity of the cutaneous burns it may produce, and its potential for systemic and occasionally lethal toxicity. The literature on the treatment of HF injuries is extensive, though occasionally confusing and often contradictory, with no coherent management policy emerging. In this paper we present a comprehensive account of the evolution of therapy, drawing on clinical reports and experimental studies.

Burns, Chemical↗

Survival following hydrofluoric acid ingestion.

Systemic toxicity after significant dermal exposure to hydrofluoric acid includes rapid development of hypocalcemia and hyperkalemia, leading to ventricular fibrillation. Similar dysrhythmias have occurred in patients after ingestion of sodium fluoride-containing compounds. Ingestion of hydrofluoric acid could induce similar cardiac toxicity; however, reported cases of hydrofluoric acid ingestion rarely have been described, and the rapid death of these patients has not allowed verification of this hypothesis. On two separate occasions, a 70-year-old woman ingested up to 2 oz of a 8% hydrofluoric acid-containing solution. Recurrent ventricular fibrillation with concurrent hypocalcemia and hypomagnesemia complicated her first episode, whereas a more aggressive administration of calcium and magnesium may have prevented dysrhythmias in the second episode. Survival from ventricular fibrillation after hydrofluoric acid ingestion has not been reported previously and suggests a role for aggressive empiric calcium and magnesium replacement.

Aged↗