History: A 35 yr old male working with germicides accidentally came in contact with hydrofluoric acid presented to ED with blue-gray appearance with surrounding erythema of skin with extreme pain. How will you manage this in your ED?
Answer: Decontaminate the patient by removing contaminated clothing and do copious irrigation for 15-30 mins.
- Apply 2.5 % Calcium gluconate gel LA.
- Inj 10% Calcium gluconate ID at rate of 0.5mL/cm2 OR 40 ml D5 + 10 mL 10% calcium gluconate infusion over 4 hrs.
Investigation: VBG, ECG, serum electrolytes.
Hydrofluoric acid (HF) quickly penetrates the skin, where fluoride ions react with calcium and magnesium, causing significant electrolyte disturbances such as hypocalcemia and hypomagnesemia. Additionally, HF inhibits potassium channels, leading to hyperkalemia. These abnormalities can trigger severe cardiac arrhythmias, including ventricular fibrillation, which can be fatal. A notable symptom of HF burns is intense pain disproportionate to the injury, attributed to potassium depletion from nerve endings.