Hydrofluoric acid burn

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Hydrofluoric acid burn
Other namesHydrofluoric acid toxicity
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A hydrofluoric acid burn of the hand
Specialty Toxicology
Symptoms Severe pain at the site of exposure [1]
Complications electrolyte, heart, lung, and neurological problems [1]
Usual onsetImmediate or delayed [1]
Causes Hydrofluoric acid [1]
Diagnostic method Based on history of exposure and symptoms [2]
TreatmentRemoving contaminated clothing, washing with water, calcium gluconate [1]
FrequencyRare [1]

A hydrofluoric acid burn is a chemical burn from hydrofluoric acid. [1] Where it contacts the skin it results in significant pain, swelling, redness, and skin breakdown. [1] [2] If the fumes are breathed in swelling of the upper airway and bleeding may occur. [2] Complications can include electrolyte, heart, lung, kidney, and neurological problems. [1] [2]

Contents

Most exposures occur at work. [2] With concentrations less than 7%, onset of symptoms may not occur for hours while with concentrations greater than 15% onset of symptoms is nearly immediate. [1] Diagnosis should include blood tests for calcium, potassium, and magnesium along with an electrocardiogram. [1]

Initial treatment of exposure involves removing contaminated clothing and washing with large amounts of water over at least 30 minutes. [1] Other measures include applying calcium gluconate cream. [1] It is estimated that about a thousand cases occur each year globally. [1] Most people affected are adult males. [1]

Signs and symptoms

HF burns, not evident until a day after HF burned hands.jpg
HF burns, not evident until a day after

Symptoms of HF exposure include irritation of the eyes, skin, nose, and throat; eye and skin burns; and bone damage. [3]

Complications may occur due to fluoride toxicity. [1] Once absorbed into blood through the skin, [1] it reacts with blood calcium and may cause cardiac arrest. Burns with areas larger than 160 cm2 (25 square inches) have the potential to cause serious systemic toxicity from interference with blood and tissue calcium levels. [4] In some cases, exposures can lead to hypocalcemia.

Breathing in the HF fumes can result in fevers, pulmonary edema (fluid buildup in the lungs), bleeding, and low blood oxygen. [2]

Cause

Hydrogen fluoride is used in a number of industries including glass etching and electronics manufacturing. [2]

It is generated upon combustion of many fluorine-containing compounds such as products containing Viton and polytetrafluoroethylene (Teflon) parts. [5] Hydrofluorocarbons in automatic fire suppression systems can release hydrogen fluoride at high temperatures, and this has led to deaths from acute respiratory failure in military personnel when a rocket-propelled grenade hit the fire suppression system in their vehicle. [6] Hydrofluoric acid can be released from volcanoes, sea salt aerosol, and from welding or manufacturing processes. [7]

Pathophysiology

In the body, hydrofluoric acid reacts with the ubiquitous biologically important ions Ca2+ and Mg2+. Formation of insoluble calcium fluoride is proposed as the cause for both precipitous fall in serum calcium and the severe pain associated with tissue toxicity. [8]

Diagnosis

Diagnosis should include blood tests for calcium, potassium, and magnesium along with an electrocardiogram (ECG). [1] ECG changes may include QRS widening and a prolonged QT interval. [2]

Treatment

Initial treatment of exposure involves removing contaminated clothing and washing the affected area with large amount of water over at least 30 minutes. [1] Calcium gluconate cream is then usually applied. [1] If pain continues calcium gluconate can be injected into the affected area or given by injection into a vein or artery. [2] Surgical removal of the affected tissue may be required. [2]

The calcium gluconate is a source of Ca2+ that sequesters the fluoride ions. Other special rinsing solutions may also be used. [9] [10] Hexafluoride Solution has been used to mitigate the adverse effects of chemical burns and counteract the effect of calcium precipitation [11] [ self-published source ], due to the triple effect of rinsing and diluting like water, neutralization of the hydrogen ions and chelation of the fluoride ions. However, further studies have found the efficacy of the solution in reducing the longer term effects of electrolyte imbalance is almost identical to that of water rinsing. [12] [13] [1]

Inhaled HF may require oxygen therapy and tracheal intubation. [2] In this situation nebulized calcium gluconate may be used. [2]

In all cases involving any amount of hydrofluoric acid burn, emergency services should be contacted immediately.

Related Research Articles

<span class="mw-page-title-main">Halogen</span> Group of chemical elements

The halogens are a group in the periodic table consisting of six chemically related elements: fluorine (F), chlorine (Cl), bromine (Br), iodine (I), and the radioactive elements astatine (At) and tennessine (Ts), though some authors would exclude tennessine as its chemistry is unknown and is theoretically expected to be more like that of gallium. In the modern IUPAC nomenclature, this group is known as group 17.

<span class="mw-page-title-main">Soman</span> Chemical compound (nerve agent)

Soman is an extremely toxic chemical substance. It is a nerve agent, interfering with normal functioning of the mammalian nervous system by inhibiting the enzyme cholinesterase. It is an inhibitor of both acetylcholinesterase and butyrylcholinesterase. As a chemical weapon, it is classified as a weapon of mass destruction by the United Nations according to UN Resolution 687. Its production is strictly controlled, and stockpiling is outlawed by the Chemical Weapons Convention of 1993 where it is classified as a Schedule 1 substance. Soman was the third of the so-called G-series nerve agents to be discovered along with GA (tabun), GB (sarin), and GF (cyclosarin).

Fluoride is an inorganic, monatomic anion of fluorine, with the chemical formula F
, whose salts are typically white or colorless. Fluoride salts typically have distinctive bitter tastes, and are odorless. Its salts and minerals are important chemical reagents and industrial chemicals, mainly used in the production of hydrogen fluoride for fluorocarbons. Fluoride is classified as a weak base since it only partially associates in solution, but concentrated fluoride is corrosive and can attack the skin.

<span class="mw-page-title-main">Hydrofluoric acid</span> Solution of hydrogen fluoride in water

Hydrofluoric acid is a solution of hydrogen fluoride (HF) in water. Solutions of HF are colorless, acidic and highly corrosive. A common concentration is 49% (48-52%) but there are also stronger solutions and pure HF has a boiling point near room temperature. It is used to make most fluorine-containing compounds; examples include the commonly used pharmaceutical antidepressant medication fluoxetine (Prozac) and the material PTFE (Teflon). Elemental fluorine is produced from it. It is commonly used to etch glass and silicon wafers.

<span class="mw-page-title-main">Chemical burn</span> Medical condition

A chemical burn occurs when living tissue is exposed to a corrosive substance or a cytotoxic agent. Chemical burns follow standard burn classification and may cause extensive tissue damage. The main types of irritant and/or corrosive products are: acids, bases, oxidizers / reducing agents, solvents, and alkylants. Additionally, chemical burns can be caused by biological toxins and by some types of cytotoxic chemical weapons, e.g., vesicants such as mustard gas and Lewisite, or urticants such as phosgene oxime.

Calcium fluoride is the inorganic compound of the elements calcium and fluorine with the formula CaF2. It is a white solid that is practically insoluble in water. It occurs as the mineral fluorite (also called fluorspar), which is often deeply coloured owing to impurities.

Fluoride toxicity is a condition in which there are elevated levels of the fluoride ion in the body. Although fluoride is safe for dental health at low concentrations, sustained consumption of large amounts of soluble fluoride salts is dangerous. Referring to a common salt of fluoride, sodium fluoride (NaF), the lethal dose for most adult humans is estimated at 5 to 10 g. Ingestion of fluoride can produce gastrointestinal discomfort at doses at least 15 to 20 times lower than lethal doses. Although it is helpful topically for dental health in low dosage, chronic ingestion of fluoride in large amounts interferes with bone formation. In this way, the most widespread examples of fluoride poisoning arise from consumption of ground water that is abnormally fluoride-rich.

<span class="mw-page-title-main">Gluconic acid</span> Chemical compound

Gluconic acid is an organic compound with molecular formula C6H12O7 and condensed structural formula HOCH2(CHOH)4CO2H. A white solid, it forms the gluconate anion in neutral aqueous solution. The salts of gluconic acid are known as "gluconates". Gluconic acid, gluconate salts, and gluconate esters occur widely in nature because such species arise from the oxidation of glucose. Some drugs are injected in the form of gluconates.

<span class="mw-page-title-main">Sodium fluoride</span> Ionic compound (NaF)

Sodium fluoride (NaF) is an inorganic compound with the formula NaF. It is a colorless or white solid that is readily soluble in water. It is used in trace amounts in the fluoridation of drinking water to prevent tooth decay, and in toothpastes and topical pharmaceuticals for the same purpose. In 2021, it was the 291st most commonly prescribed medication in the United States, with more than 600,000 prescriptions. It is also used in metallurgy and in medical imaging.

<span class="mw-page-title-main">Potassium fluoride</span> Ionic compound (KF)

Potassium fluoride is the chemical compound with the formula KF. After hydrogen fluoride, KF is the primary source of the fluoride ion for applications in manufacturing and in chemistry. It is an alkali halide salt and occurs naturally as the rare mineral carobbiite. Solutions of KF will etch glass due to the formation of soluble fluorosilicates, although HF is more effective.

<span class="mw-page-title-main">Calcium lactate</span> Chemical compound

Calcium lactate is a white crystalline salt with formula C
6
H
10
CaO
6
, consisting of two lactate anions H
3
C
(CHOH)CO
2
for each calcium cation Ca2+
. It forms several hydrates, the most common being the pentahydrate C
6
H
10
CaO
6
·5H
2
O
.

<span class="mw-page-title-main">Hydrogen fluoride</span> Chemical compound

Hydrogen fluoride (fluorane) is an inorganic compound with chemical formula HF. It is a very poisonous, colorless gas or liquid that dissolves in water to yield an aqueous solution termed hydrofluoric acid. It is the principal industrial source of fluorine, often in the form of hydrofluoric acid, and is an important feedstock in the preparation of many important compounds including pharmaceuticals and polymers, e.g. polytetrafluoroethylene (PTFE). HF is also widely used in the petrochemical industry as a component of superacids. Due to strong and extensive hydrogen bonding, it boils at near room temperature, much higher than other hydrogen halides.

<span class="mw-page-title-main">Hexafluorosilicic acid</span> Octahedric silicon compound

Hexafluorosilicic acid is an inorganic compound with the chemical formula H
2
SiF
6
. Aqueous solutions of hexafluorosilicic acid consist of salts of the cation and hexafluorosilicate anion. These salts and their aqueous solutions are colorless.

<span class="mw-page-title-main">Ammonium bifluoride</span> Chemical compound

Ammonium bifluoride is the inorganic compound with the formula [NH4][HF2] or [NH4]F·HF. It is produced from ammonia and hydrogen fluoride. This colourless salt is a glass-etchant and an intermediate in a once-contemplated route to hydrofluoric acid.

<span class="mw-page-title-main">Aluminium fluoride</span> Chemical compound

Aluminium fluoride is an inorganic compound with the formula AlF3. It forms hydrates AlF3·xH2O. Anhydrous AlF3 and its hydrates are all colorless solids. Anhydrous AlF3 is used in the production of aluminium. Several occur as minerals.

<span class="mw-page-title-main">Calcium gluconate</span> Chemical compound

Calcium gluconate is the calcium salt of gluconic acid and is used as a mineral supplement and medication. As a medication it is used by injection into a vein to treat low blood calcium, high blood potassium, and magnesium toxicity. Supplementation is generally only required when there is not enough calcium in the diet. Supplementation may be done to treat or prevent osteoporosis or rickets. It can also be taken by mouth but is not recommended for injection into a muscle.

<span class="mw-page-title-main">Fluorine</span> Chemical element, symbol F and atomic number 9

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<span class="mw-page-title-main">Biological aspects of fluorine</span>

Fluorine may interact with biological systems in the form of fluorine-containing compounds. Though elemental fluorine (F2) is very rare in everyday life, fluorine-containing compounds such as fluorite occur naturally as minerals. Naturally occurring organofluorine compounds are extremely rare. Man-made fluoride compounds are common and are used in medicines, pesticides, and materials. Twenty percent of all commercialized pharmaceuticals contain fluorine, including Lipitor and Prozac. In many contexts, fluorine-containing compounds are harmless or even beneficial to living organisms; in others, they are toxic.

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Sodium bifluoride is the inorganic compound with the formula Na[HF2]. It is a salt of sodium cation and bifluoride anion. It is a white, water-soluble solid that decomposes upon heating. Sodium bifluoride is non-flammable, hygroscopic, and has a pungent smell. Sodium bifluoride has a number of applications in industry.

Topical fluorides are fluoride-containing drugs indicated in prevention and treatment of dental caries, particularly in children's primary dentitions. The dental-protecting property of topical fluoride can be attributed to multiple mechanisms of action, including the promotion of remineralization of decalcified enamel, the inhibition of the cariogenic microbial metabolism in dental plaque and the increase of tooth resistance to acid dissolution. Topical fluoride is available in a variety of dose forms, for example, toothpaste, mouth rinses, varnish and silver diamine solution. These dosage forms possess different absorption mechanisms and consist of different active ingredients. Common active ingredients include sodium fluoride, stannous fluoride, silver diamine fluoride. These ingredients account for different pharmacokinetic profiles, thereby having varied dosing regimes and therapeutic effects. A minority of individuals may experience certain adverse effects, including dermatological irritation, hypersensitivity reactions, neurotoxicity and dental fluorosis. In severe cases, fluoride overdose may lead to acute toxicity. While topical fluoride is effective in preventing dental caries, it should be used with caution in specific situations to avoid undesired side effects.

References

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  5. Koch, Ernst-Christian (2002). "Metal-Fluorocarbon-Pyrolants IV: Thermochemical and Combustion Behaviour of Magnesium/Teflon/Viton (MTV)". Propellants, Explosives, Pyrotechnics . 27 (6): 340–351. doi:10.1002/prep.200290004.
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  7. "CDC – The Emergency Response Safety and Health Database: Systemic Agent: HYDROGEN FLUORIDE/ HYDROFLUORIC ACID – NIOSH". www.cdc.gov. Retrieved 2015-12-04.
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  9. Hultén P, Höjer J, Ludwigs U, Janson A (2004). "Hexafluorine vs. standard decontamination to reduce systemic toxicity after dermal exposure to hydrofluoric acid". J. Toxicol. Clin. Toxicol. 42 (4): 355–61. doi:10.1081/CLT-120039541. PMID   15461243. S2CID   27090208.
  10. "News & Views". Chemical Health and Safety. 12 (5): 35–37. September–October 2005. doi:10.1016/j.chs.2005.07.007.
  11. "The HEXAFLUORINE® solution - PREVOR". Prevor EN. Retrieved 2022-10-26.
  12. Hultén, Peter; Höjer, J.; Ludwigs, U.; Janson, A. (2004). "Hexafluorine vs. Standard Decontamination to Reduce Systemic Toxicity After Dermal Exposure to Hydrofluoric Acid". Journal of Toxicology: Clinical Toxicology. 42 (4): 355–361. doi:10.1081/CLT-120039541. ISSN   0731-3810. PMID   15461243. S2CID   27090208.
  13. Bajraktarova-Valjakova, Emilija; Korunoska-Stevkovska, Vesna; Georgieva, Silvana; Ivanovski, Kiro; Bajraktarova-Misevska, Cvetanka; Mijoska, Aneta; Grozdanov, Anita (2018-11-20). "Hydrofluoric Acid: Burns and Systemic Toxicity, Protective Measures, Immediate and Hospital Medical Treatment". Open Access Macedonian Journal of Medical Sciences. 6 (11): 2257–2269. doi:10.3889/oamjms.2018.429 (inactive 2024-03-11). ISSN   1857-9655. PMC   6290397 . PMID   30559898.{{cite journal}}: CS1 maint: DOI inactive as of March 2024 (link)