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PubMed1980

Fatality due to acute systemic fluoride poisoning following a hydrofluoric acid skin burn.

Reports indicate that death due to hydrofluoric acid exposure is usually the result of inhalation of vapor causing pulmonary edema and fluoride poisoning. Absorption via the skin route of fluoride ion sufficient to cause serious systemic problems and even death has rarely been reported. A fatality resulting from a severe facial burn, which produced acute systemic fluoride poisoning with profound hypocalcemia and hypomagnesemia, is presented. The importance of proper personal protective equipment as well as the immediate initiation of first aid and appropriate medical measures, including the monitoring and replacement of serum calcium and magnesium, are emphasized.

Acute Disease↗
PubMed1975

Effect of hydrofluoric acid on glucose metabolism of the mouse studied by whole-body autoradiography.

Distribution of radioactive carbon from [U-14C]glucose in the mouse poisoned by hydrofluoric acid has been studied by whole-body autoradiography. Under normal conditions, the highest autoradiographic density was found in the Harder's gland, palatine gland, sublingual gland, large intestinal mucosa, and many regions of the central nervous system 30 minutes after intraperitoneal injection of [U-14C]glucose. On the other hand, after hydrofluoric acid poisoning, it was found that (1) the radioactivity of brain was unchanged throughout all the poisoning; (2) the liver, renal cortex, lung, and blood showed an increase in radioactivity at 180 minutes of poisoning; (3) the abdominal cavity showed a tendency to residual radioactivity with the poisoning; (4) by contrast, Harder's gland, the palatine gland, sublingual gland, and large intestinal mucosa showed a decrease in radioactivity at 180 minutes of poisoning.

Acids↗
PubMed1989

Occupational medicine in Oklahoma: hydrofluoric acid dangers.

Occupational Medicine is the study of the interaction of workers with their workplace and the workplace's effect on the workers' health. In addition, many workplaces have the potential to affect the community as a whole. Herein is reported a brief case of community-wide exposure to the powerful oxidant, hydrofluoric acid. A discussion of sources and uses of hydrofluoric acid along with emergent care of burn victims is also presented. Even as this paper was being prepared, a second toxic cloud (sulfuric acid) was released in the Tulsa area. Clearly physicians should be aware of potential environmental impacts of occupational hazards.

Accidents, Occupational↗
PubMed2005

[Hydrofluoric acid burns. A rare chemical emergency situation].

Burns caused by hydrofluoric acid can be life-threatening. Of special significance is the often underestimated local and sometimes delayed deep action of the highly diffusible free fluoride ions and the accompanying systemic toxicity. The specific antidote calcium gluconate can be topically applied, injected into tissue or infused intra-arterially. Because of the extreme danger of systemic toxicity even after seemingly trivial injuries, monitoring in the intensive care station, especially by measuring the calcium concentration in blood and electrocardiography, and therapy is recommended.

Administration, Topical↗
PubMedDate not supplied

Fatal hydrofluoric acid cutaneous exposure with refractory ventricular fibrillation.

A patient with hydrofluoric acid burns involving only 8% of his body surface area died from intractable cardiac arrhythmia secondary to the depletion of ionized calcium by fluoride ion. For burns of this type, immediate subcutaneous injection of 10% calcium gluconate into the burn wound is recommended and the dose given should be titrated to the relief of local pain. Immediate debridgement of the burn wound also can decrease the treacherous aspect of the circulating fluoride ion, which binds to calcium to form an insoluble salt, effectively removing the calcium ion from any physiologic interaction.

Burns, Chemical↗
PubMed1988

Hydrofluoric acid burns of the hand: mechanism of injury and treatment.

Hydrofluoric acid is one of the strongest inorganic acids and is used extensively in industry and research. It differs from other acids in that the fluoride ion readily penetrates the skin, causing destruction of deep tissue layers and even bone. Authors have previously described numerous topical treatments. This report describes one method of treatment emphasizing immediate skin cleansing and the application of calcium gluconate gel, which is followed by calcium gluconate subcutaneous injections when necessary. An accurate occupational history and physical examination are important aspects of patient assessment. Prompt treatment resulted in relief of pain and a satisfactory clinical result in all cases. A significant delay in treatment was responsible for permanent impairment in 2 of 14 patients.

Adult↗
PubMed1988

Acute hydrofluoric acid exposure.

Significant local and systemic toxicity may occur from hydrofluoric acid by all routes of exposure. Prompt decontamination by removal from the source and copious irrigation of eyes and skin are essential to reduce morbidity and mortality. Ingestion of small amounts of HF can lead to rapid systemic poisoning and death. Calcium gluconate therapy has become the preferred method of detoxifying the fluoride ion, although its efficacy is based mainly on anecdotal reports and poorly controlled clinical studies. Therefore, more basic research is needed to elucidate the pathophysiology of local toxicity and the best therapeutic modalities to limit injury. All significant exposures should be evaluated by health care personnel familiar with the potential toxicity of this compound.

Accidents↗
PubMed1993

Fulminant acute colitis following a self-administered hydrofluoric acid enema.

A 33-yr-old white male presented with bloody diarrhea, leukocytosis, and left lower quadrant direct and rebound tenderness after a self-administered concentrated hydrofluoric acid enema while intoxicated from intranasal cocaine administration. Intraoperative flexible sigmoidoscopy and a gastrografin enema revealed severe mucosal ulceration and edema in the rectum and sigmoid colon. Laparotomy revealed an ulcerated, necrotic, and purulent sigmoid colon and intraperitoneal pus. The patient underwent a limited sigmoid resection and a Hartman procedure. Five months later, the patient presented with a rectal stricture which was resected. This case demonstrates that a hydrofluoric acid enema can cause fulminant acute colitis and chronic colonic strictures.

Acute Disease↗
PubMed2002

Ion chromatographic analysis of anions in ammonium hydroxide, hydrofluoric acid, and slurries, used in semiconductor processing.

In this study, ion chromatography (IC) with suppressed conductivity detection was used for the determination of trace anions in 29% (w/w) ammonium hydroxide, 49% (w/w) hydrofluoric acid and slurries. For these samples, various sample pretreatment methods were applied to eliminate matrix interferences. For concentrated ammonium hydroxide, an on-line electrochemical neutralizer (SP10 AutoNeutralization module) was used to neutralize the base prior to the IC analysis. For concentrated hydrofluoric acid, a heart cutting technique with an ion-exclusion column was used to separate the anions of interest prior to an IC separation. A method was also developed to analyze chloride in silica slurries by IC.

Ammonium Hydroxide↗
PubMed2003

Surface characteristics of dentin experimentally exposed to hydrofluoric acid.

The purpose of this study was to test the effect of hydrofluoric acid (HF) on the surface characteristics of dentin in vitro. Dentin was exposed in 50 human molars and divided into five groups according to different etching schedules: (i) no etching, (ii) 15 s HF, (iii) 15 s H3PO4, (iv) 15 s HF and 15 s H3PO4, (v) 15 s H3PO4 and 15 s HF. Teeth were examined under a scanning electron microscope equipped with energy-dispersive X-ray (EDX) or two layers of fluorescence-labeled primer followed by the composite were applied, and the teeth were sectioned and examined using confocal laser scanning microscopy (CLSM). With scanning electron microscopy, no openings of dentinal tubules were found in groups (i), (ii), and (iv). In group (v) only a few tubules were opened and in group (iii) the smear layer was completely removed and tubules appeared open. The EDX analysis revealed that fluoride was incorporated into the dentin surface when HF was used. With CLSM, distinct hybrid layers could be detected only in group (iii). In group (v) the hybrid layer appeared less established compared with group (iii). No dentin hybridization was found in groups (i), (ii), and (iv). It is concluded that HF has the ability to close the openings of dentin tubules which were opened due to etching by phosphoric acid and cannot dissolve the smear layer.

Acid Etching, Dental↗
PubMedDate not supplied

Treatment of hydrofluoric acid burn to the face by carotid artery infusion of calcium gluconate.

Hydrofluoric acid (HF) is highly corrosive substance often used in industrial processes. HF burns to the skin cause local tissue injury. Systemic hypocalcemia may ensue, with the potential to produce life-threatening arrhythmias. Medical treatment consists of local application of topical calcium gels, subcutaneous injection of calcium gluconate, and intravenous or intra-arterial infusion of calcium gluconate. Calcium gluconate infusions have been used for HF burns on distal extremities and digits. We report a case of HF burn to the face that was treated by the use of calcium gluconate infusion via the external carotid artery.

Accidents, Occupational↗
PubMed1987

Urinary fluoride monitoring of industrial hydrofluoric acid exposure.

Preworkshift and postworkshift urinary fluoride concentrations were measured in 142 hydrofluoric acid (HF) workers and 82 unexposed workers aged 18 to 59. Postshift urinary fluoride concentration in HF workers was significantly higher than that in preshift or control workers. A linear relationship was observed between the mean values in urinary fluoride concentration and the HF concentration in the air. The mean urinary fluoride concentration of 4 ppm and its lower fiducial limit (95%, P = 0.05) of 2 ppm (specific gravity 1.024) were estimated corresponding to the atmospheric HF concentration of 3 ppm, which is the maximal allowable concentration recommended by the Japanese Association of Industrial Health and also the threshold limit value suggested by the American Conference of Governmental Industrial Hygienists. The results suggest that exposure to HF can be monitored by determining the urinary fluoride concentration.

Adolescent↗
PubMed2005

The electrocardiographic toxidrome: the ECG presentation of hydrofluoric acid ingestion.

The clinician can approach the poisoned patient using the toxidrome system of toxin identification; this approach makes use of findings noted on the physical examination, highlighting the importance of abnormalities in blood pressure, heart rate, respiratory effort, body temperature, mental status, pupillary size, skin color, diaphoresis, and gastrointestinal sounds. Such a method provides structure and guidance to the clinical evaluation, providing the clinician with rapid diagnostic information and suggesting urgent management issues. A case of hydrofluoric acid poisoning is used as an example of this diagnostic approach. The patient demonstrated systemic toxicity accompanied by oral irritation and electrocardiographic abnormality (QRS complex widening and QT interval prolongation). The constellation of these findings suggested the possibility of a caustic agent (history and examination) with potential effect on potassium and calcium metabolism (electrocardiographic abnormalities). Such a constellation strongly suggested hydrofluoric acid as the culprit toxin.

Acidosis↗
PubMed1997

The efficacy of calcium gluconate in ocular hydrofluoric acid burns.

1. Although calcium gluconate (CG) is recommended in the treatment of hydrofluoric acid (HF) eye burn its efficacy seems to be controversial, and controlled human or animal studies are limited. The study's objective is to compare the efficacy of 1% CG and normal saline irrigation for the treatment of HF eye injury in animals. 2. 0.05 ml 2% HF was instilled to anesthetized rabbit's eyes. One minute later, four treatment groups were studies: (1) irrigation with normal saline followed by topical antibiotics, corticosteroids and cycloplegics for 48 h (n = 10); (2) irrigation with 1% CG followed by the same topical treatment (n = 9); (3) as group 1 and 1% CG drops over 48 h (n = 10); (4) as group 3, and injection of 1% CG subconjunctivally after irrigation (n = 9). 3. Corneal erosion area, corneal haziness, conjunctival status, vascularization (pannus) and acidity were assessed before injury, immediately after initial treatment and 1, 2, 7 and 14 days thereafter by slit lamp aided by fluorescein staining. 4. Conjunctival pH dropped from 6.0-6.5 to 2.5-3 after injury and increased to 6-6.5 after irrigation. Corneal erosion: smaller in groups 2, 3, significantly so at 2 days, but not different at 14 days. Corneal haziness: more severe in group 4, at 14 days, insignificant. Conjunctival damage: significantly worse in group 4 at 2, 7 and 14 days. Pannus appeared in 2-4 eyes in each group. 5. It seems that for HF injury 1% CG did not have any significant advantage over saline irrigation and topical treatment only. It might have some initial and temporary effect on healing process especially that involving erosion. Given subconjunctivally, 1% CG may be toxic and worsens clinical outcome.

Administration, Topical↗
PubMed1979

[A new treatment method of hydrofluoric acid burns of the extremities].

A new method to arrest the unremitting progression of hydrofluoric acid burns, which occurs in the absence of appropriate therapy, is described. The treatment consists of repeated perfusions of calcium gluconate into one of the arteries supplying the affected areas. To date 11 patients have been treated in the described manner, and the therapy brought about recovery in all cases, with little loss of tissue or function.

Burns, Chemical↗
PubMed2001

Efficacy of hexafluorine for emergent decontamination of hydrofluoric acid eye and skin splashes.

Hexafluorine is an amphoteric, hypertonic, polyvalent compound for decontaminating hydrofluoric acid (HF) eye and skin splashes. In a German metallurgy facility during the period of 1994-1998, all eye or skin splashes with 40% HF alone or with a 6% HF/15% HNO3 mixture were initially decontaminated with Hexafluorine within 2 min following the splash at the accident site by the victims themselves or co-workers who witnessed the accident. Eleven workers using 40% HF or a 6% HF/15% HNO3 mixture sustained eye (2 cases) or skin (10 cases) splashes (1 combined) during 1994-1998. Hexafluorine was used within 2 min, and a second Hexafluorine decontamination was done on arrival at the plant infirmary. No further medical or surgical treatment was needed, no workers developed chemical burns, and none lost work time. These II cases demonstrate the efficacy of Hexafluorine in decontaminating HF or combined HF/HNO3 splashes.

Accidents, Occupational↗