special subjects
Hydrofluoric Acid Exposure
Key Points
Dermal, oral, inhalational, and ocular exposures to hydrofluoric acid may occur in the workplace. Symptoms begin immediately after exposure to concentrated HF formulations but may be delayed by several hours after exposure to dilute HF formulations. Surface burns and the complexation of calcium or magnesium with the fluoride ion in HF results in local hypocalcemia and hypomagnesemia, which cause cellular dysfunction and death. Treat dermal burns and severe pain due to dermal exposure with dermal, subcutaneous, or intra-arterial calcium; transfer almost all patients with burns to a burn center. For oral exposures, use an orogastric or nasogastric tube to empty the stomach as soon as possible; ingestion of concentrated HF solution is toxic as well as caustic and can be fatal. Treat patients with inhalational exposure with nebulizedcalcium gluconate; treat patients who have had a more concentrated exposure and who have ARDS-like symptoms with the usual treatments for ARDS. Admit patients with systemic fluoride toxicity (which may be due to dermal, oral, or inhalational exposure) to an intensive care unit for serial monitoring and support, and treat them with IV magnesium and calcium and, if needed, vasopressors. After ocular exposure, irrigate the eyes immediately, continuously, and thoroughly and arrange consultation and follow-up with an ophthalmologist. 