Hydrofluoric Acid Burns Clinical Presentation
- Author: Garry Wilkes, MBBS, FACEM; Chief Editor: Joe Alcock, MD, MS more...
Time of exposure to onset of symptoms is related to the concentration of the hydrofluoric acid, as follows:
- Solutions of 14.5% and higher concentrations immediately produce symptoms.
- Solutions of 12% may take up to an hour to produce symptoms.
- Solutions of less than 7% may take several hours before onset of symptoms, resulting in delayed presentation, deeper penetration of the undissociated HF acid, and a more severe burn.
- Concentrated solutions cause immediate pain and produce surface burns similar to those produced by other common acids (eg, erythema, blistering, necrosis).
Pain typically is described as deep, burning, or throbbing. Pain often is disproportionate to apparent skin involvement.
Obtain a history of potential exposure to cleaning solutions within the last 24 hours, to include the following:
- Duration and type of exposure - Skin, ophthalmic, gastrointestinal (vomiting, abdominal pain), and pulmonary (throat burning, dyspnea)
- Concentration of acid
- Use of protective measures
- Other agents in the solution
- Symptoms of hypocalcemia - Tetany, Chvostek sign, Trousseau sign
- Cardiac arrhythmias
- Additionally, obtain history of medications and intercurrent illness that predispose patient to hypocalcemia or hypomagnesemia.
Weaker solutions penetrate before dissociating. Surface involvement in these cases is minimal and may be absent.
Three categories of appearance include the following:
- Grade 2 - A white burn mark and/or erythema and pain, plus edema and blistering
Patients with inhalation burns may develop acute lung injury presenting with the following:
Ocular burns may present with severe pain.
McIvor ME. Delayed fatal hyperkalemia in a patient with acute fluoride intoxication. Ann Emerg Med. 1987 Oct. 16(10):1165-7. [Medline].
Stuke LE, Arnoldo BD, Hunt JL, Purdue GF. Hydrofluoric acid burns: a 15-year experience. J Burn Care Res. 2008 Nov-Dec. 29(6):893-6. [Medline].
Dalamaga M, Karmaniolas K, Nikolaidou A, Papadavid E. Hypocalcemia, hypomagnesemia, and hypokalemia following hydrofluoric acid chemical injury. J Burn Care Res. 2008 May-Jun. 29(3):541-3. [Medline].
Songur MK, Akdemir O, Lineaweaver WC, Cavusoglu T, Ozsarac M, Aktug H, et al. Comparison of skin effects of immediate treatment modalities in experimentally induced hydrofluoric acid skin burns. Int Wound J. 2014 Jan 29. [Medline].
Burgher F, Mathieu L, Lati E, et al. Experimental 70% hydrofluoric acid burns: histological observations in an established human skin explants ex vivo model. Cutan Ocul Toxicol. 2011 Jun. 30(2):100-7. [Medline]. [Full Text].
Wilkes GJ. Intravenous regional calcium gluconate for hydrofluoric acid burns of the digits. Emerg Med (Aust). 1993. 5:155-8.
Wilkes GJ, Morel DG. Hydrofluoric acid burns of the hands. In: Abstracts of the 6th International Conference on Emergency Medicine. Sydney. 1996.
Wu ML, Deng JF, Fan JS. Survival after hypocalcemia, hypomagnesemia, hypokalemia and cardiac arrest following mild hydrofluoric acid burn. Clin Toxicol (Phila). 2010 Nov. 48(9):953-5. [Medline].