special subjects
Hydrofluoric Acid Exposure
Prognosis for Hydrofluoric Acid Exposure
Prognosis depends on the route of hydrofluoric acid exposure. Prognosis after mild dermal HF exposure is good if the patient is promptly evaluated and treated. As with other chemical burns, symptoms typically resolve over a period of days to weeks, depending on the severity of the burn. Patients who have ingested a dilute HF solution may develop reversible oropharyngeal or gastrointestinal (GI) irritation or may remain asymptomatic and have a benign prognosis. Ingestion of concentrated HF solution may result in fatal GI hemorrhage or systemic fluoride toxicity, which may be fatal. If patients with severe GI burns survive, long-term sequelae including strictures may develop. Patients with systemic fluoride toxicity are at high risk of cardiac arrhythmia and hypotension. Prognosis after inhalational exposure depends on the intensity and chronicity of exposure. If inhalational exposure is mild to moderate, symptoms may resolve spontaneously over a period of hours to days. More intense exposures may result in persistent upper airway irritation (reactive upper airways dysfunction syndrome [RUDS]) or pulmonary irritation (reactive airways dysfunction syndrome [RADS]) that persists for months to years. Chronic occupational HF exposure may result in a bronchial hyperreactivity syndrome called "potroom worker’s asthma". Serial pulmonary function tests may be used to monitor RADS and bronchial hyperreactivity in workers exposed to HF. If ocular exposure is mild, conjunctival irritation and chemosis (which typically occurs) resolves over a period of several days, and no long-term sequelae are anticipated. If exposure is more severe, corneal injury or sloughing may result in chronic conjunctivitis, corneal opacification or vascularization, glaucoma, or keratitis sicca. 