Hydrofluoric Acid Burns

What is Hydrofluoric Acid Burns?

Hydrofluoric acid was first discovered in 1771 by Swedish pharmaceutical chemist Carl Wilhelm Scheele while he was studying a mineral known as fluorite (or Calcium fluoride). Hydrofluoric acid is also known as Hydrogen fluoride, Fluoric acid, Hydrofluoride, Fluorine monohydride, and Fluorane. This extremely strong industrial acid is widely used in several sectors including the production of aluminum, stainless steel, hydrofluorocarbons, glass etching, various manufacturing industries, and as the starting material for all pharmaceutical fluoride-based compounds.

In our everyday lives, hydrofluoric acid can be found in products like rust removers, detergents, stone cleaners, toilet bowl cleaners, insecticides, car wheel cleaners, and air conditioner cleaners. Hydrofluoric acid in its gaseous form consists of hydrogen and fluoride atoms. When it turns into a liquid, it forms strong hydrogen bonds creating a polymeric compound. Depending on the concentration and impurities, hydrofluoric acid can appear from colorless to slightly tinted. It has a boiling point of 20 degrees Celsius (68 degrees Fahrenheit) and it dissolves easily in water. Hydrofluoric acid is also known for its strong, unpleasant smell and its extreme corrosiveness which allows it to dissolve many materials, particularly oxides.

Industrially, hydrofluoric acid is most commonly made by reacting fluorite with concentrated sulfuric acid at 265 degrees Fahrenheit. It can also be produced as a by-product in the manufacturing of phosphoric acid from the mineral apatite, and even via natural processes such as volcanic eruptions. Over a million tons of hydrofluoric acid is produced worldwide and is usually stored as a highly concentrated liquid under high pressure. For safety, it carries a Department of Transportation Hazard Label and National Fire Protection Association (NFPA) 704 listing which indicate potential health hazards, lack of flammability, instability under certain conditions and violent reactions with water. Typical domestic concentrations of hydrofluoric acid are around 0.5%, while industrial concentrations can be almost 100%.

Exposure to hydrofluoric acid can lead to severe health issues including skin burns, eye injuries, acute respiratory symptoms, stomach issues and heart abnormalities, which can occur from direct skin or eye contact, swallowing solutions, or breathing in fumes and vapors. Accidental exposure can occur due to improper handling, equipment failure, container explosions, leakages during transport, insufficient protective gear or accidental consumption by children. Intentional cases of consumption, often with suicidal or homicidal intent, have also been reported.

Hydrofluoric acid poses a unique danger due to its corrosive hydrogen ions and toxic fluoride ions that can penetrate deep into tissue causing liquefactive necrosis (liquefaction and death of body tissue) and the release of cellular products. This could lead to systemic toxicity which affects various bodily systems, leading to imbalances in electrolytes and inhibition of enzymes that can potentially cause abnormal heart rhythms and even death. Long-term symptoms may persist for months following consumption or inhalation.

What Causes Hydrofluoric Acid Burns?

If you come into contact with hydrofluoric acid, you need immediate, specific medical treatment to prevent the acid from penetrating into your deep tissues and spreading throughout your bloodstream. This quick medical response helps to reduce harmful effects on your organs and minimizes further damage.

Although hydrofluoric acid is technically considered a weak acid when compared to others, it is quickly absorbed through the skin, potentially resulting in severe, life-threatening burns and irregular heartbeats. In fact, with weaker solutions of the acid, the damage might even be delayed because the ions could pass through your skin before dissociating and causing complications.

Injury to the skin is the most common type of injury observed with hydrofluoric acid exposure, and burns to the fingers are particularly concerning for workers who come into contact with the acid.

Risk Factors and Frequency for Hydrofluoric Acid Burns

Hydrofluoric acid exposure is a relatively rare industrial accident, with around 1000 cases reported globally each year. However, exact incident rates are unknown. Several studies offer some insight:

A 15-year study by Stuke et al reported that out of 204 chemical burns, 35 patients (or 17%) were due to hydrofluoric acid.
A 10-year study in China found 690 patients with chemical burns, where just over half involved hydrofluoric acid and sulfuric acid. They noticed that most chemical burns happened during the summer and autumn seasons.
Over a span of 20 years, Taiwan recorded 324 incidents of hydrofluoric acid, most of which were skin-related.

Hydrofluoric acid exposure tends to happen in certain jobs, and most of the patients are adult males. The upper extremities, like the arms and hands, are most frequently affected.

Signs and Symptoms of Hydrofluoric Acid Burns

Exposure to hydrofluoric acid can lead to a variety of health problems, depending on the acid’s concentration and where the contact occurred. It can cause severe burns and intense pain right away, with stronger solutions causing immediate symptoms, and weaker ones taking hours to manifest. Both the eyes and the respiratory system are vulnerable when the acid is splashed or sprayed on the face.

When reviewing someone’s history, it’s vital to note any possible exposure to hydrofluoric acid, whether through their work environment or at home. This may involve using products like rust removers or cleaning agents that contain the acid. The concentration of the solution, how long the person was exposed, and whether protection was used should be considered. It’s also important to know if any treatments have been administered so far.

Physical evaluations have to be carried out immediately to check for life-threatening issues like difficulty breathing, irregular heartbeat, or blocked airways. In addition, other potential issues like lung fluid buildup, eye injuries, or symptoms of low calcium levels should be assessed.

Here’s a look at how various types of exposure to hydrofluoric acid can affect different parts of the body:

Skin exposure: Physical signs can include the location and color of the burn, degree of tissue death around the burn, and whether structures like tendons or bones are affected. Severely concentrated hydrofluoric acid can penetrate the skin within minutes, causing serious tissue damage and death.
Eye exposure: The first signs usually include pain and irritation, followed by eye inflammation, swelling, and congestion. The eye’s transparent cover can erode, resulting in cloudiness, while long-term exposure can lead to total loss of the eye and vision.
Inhalation exposure: Inhaling toxic gases or vapor can result in nose irritation, internal bleeding, and even punctures in the nasal septum. Depending on the acid’s concentration and how long the person was exposed, they may also experience coughing, shortness of breath, and symptoms like voice changes, spasms of the voice box, inflammation of the bronchi, stridor, wheezing, blocking of the small air passages in the lungs, bleeding in the airway, fluid buildup in the lungs, congestion, or collapsed lung.
Ingestion exposure: Swallowing hydrofluoric acid can lead to burns in the mouth, esophagus, and stomach. Symptoms include difficulty swallowing, nausea, vomiting, diarrhea, and severe abdominal pain. This can lead to gastritis, causing vomiting of blood, black, tarry stools, potential hole in the stomach.
Neuromuscular symptoms: Individuals can also develop disorders related to the nervous and muscular systems due to changes in calcium and potassium levels, which interfere with normal electric signal transmission in neurons. Signs can range from anxiety and confusion to seizures, paralysis, or even coma.

Testing for Hydrofluoric Acid Burns

If you’ve been exposed to hydrofluoric acid, it’s vital to have an immediate check for imbalances in your body’s levels of calcium, potassium, and magnesium. This is because exposure to the chemical- whether minimal or extensive- can cause these levels to fluctuate, leading to health concerns. Specifically, you can end up with too little calcium and magnesium (hypocalcemia and hypomagnesia), and too much potassium (hyperkalemia). These are key elements your body needs to function properly.

Besides these tests, monitoring your heart is also important post-exposure. Tools like EKG or ECG (electrocardiograms) can track your heartbeat and identify any irregularities. Low calcium levels can create what’s known as “QT prolongation.” This means that your heart’s electrical recharging system is taking longer than it should. Too much potassium can cause peaked T waves or arrhythmias, which are abnormal heartbeat rhythms. Lastly, low magnesium might result in a specific kind of irregular heartbeat known as “polymorphic ventricular tachycardia,” particularly one type named “Torsades de Pointes.”

If you’ve inhaled the chemical, a chest X-ray is necessary. This is to check for potential lung issues, like pulmonary edema or pneumonitis, which respectively involve fluid in your lungs and inflammation of your lungs. Monitoring of EtCO2 levels might also be considered; it checks the amount of carbon dioxide you’re breathing out and is particularly useful for those who have inhaled the chemical. To check for any kidney problems such as renal dysfunction, insufficiency, and renal cortical necrosis which refers to death of cells in the outer portion of the kidneys, a urinalysis might be conducted. This tests your urine for red and white blood cells or protein, which can indicate these issues.

Treatment Options for Hydrofluoric Acid Burns

Hydrofluoric acid is a highly corrosive and toxic substance. It’s very important to prevent exposure to this acid. Everyone who uses hydrofluoric acid should understand its toxic properties and know how to handle it safely. This includes knowing how to store, transport, and dispose of it, as well as how to clean up spills and what to do if exposure occurs. This acid should only be used in industrial or laboratory settings that are specially equipped. Likewise, household cleaning agents should be kept out of children’s reach.

When using hydrofluoric acid, you must wear correct personal protective equipment and follow safety measures. This includes wearing a lab coat, long pants, acid-resistant apron, closed-toe shoes, tightly sealed goggles and a full-face shield. Also, wear rubber gloves made from nitrile, butyl, or neoprene and use a respiratory filter device. The area where hydrofluoric acid is handled should be well ventilated, have clear warning signs, and provide easy access to a good supply of running water, a safety shower, and eyewash.

A first aid kit that includes 2.5% calcium gluconate gel and 1% calcium gluconate eyewash should be readily available in case of exposure. If someone is exposed to hydrofluoric acid, quickly assess, remove contaminated clothing and jewelry, decontaminate with a copious amount of water or saline, and start neutralization using calcium gluconate or other suitable agents.

The decontamination and neutralization process relies on lot of water to rinse and dilute the acid and to bind or chelate the fluoride ions in the acid. Calcium gluconate is particularly effective at this as it forms insoluble salts with the fluoride ions, rendering them harmless.

When the acid comes into contact with skin, the affected area should be rinsed thoroughly with either cold or warm running water or saline for at least 30 minutes and the neutralizing agent should be applied multiple times to mitigate the fluoride ions’ damage.

For eye exposures, initial treatment includes rinsing with large amounts of cool plain water or sterile 0.9% saline solution for 15-30 minutes, and then treating with a 1% calcium gluconate solution or other appropriate treatments. In the case of inhalation exposure, treatment could include providing 100% oxygen and a calcium gluconate nebulized solution

Severe burns require urgent medical attention and careful monitoring. Burns greater than four square inches need immediate intensive care monitoring and individuals who have been exposed to hydrofluoric acid gas should also be monitored in an intensive care unit. Regular measurement of blood fluoride, potassium, and calcium levels is necessary and, in some situations, dialysis might be required for fluoride removal and to correct excessive potassium and calcium levels.

Potential harm can come from several chemical sources, and they can result in different kinds of injuries such as:

Chemical burns
Chlorine toxicity
Fluoride toxicity
Burns or injuries to the eyes caused by chemicals

Frequently asked questions

Hydrofluoric acid burns are severe injuries that occur when hydrofluoric acid comes into contact with the skin or eyes. These burns can cause liquefactive necrosis, releasing cellular products and potentially leading to systemic toxicity and long-term symptoms.

Hydrofluoric acid burns are relatively rare, with around 1000 cases reported globally each year.

Signs and symptoms of hydrofluoric acid burns can vary depending on the concentration of the acid and the location of contact. Here are the specific signs and symptoms associated with different types of exposure: 1. Skin exposure: - Location and color of the burn - Degree of tissue death around the burn - Involvement of structures like tendons or bones - Severe burns can cause serious tissue damage and death within minutes. 2. Eye exposure: - Pain and irritation - Eye inflammation, swelling, and congestion - Erosion of the eye's transparent cover, resulting in cloudiness - Long-term exposure can lead to total loss of the eye and vision. 3. Inhalation exposure: - Nose irritation - Internal bleeding and punctures in the nasal septum - Coughing and shortness of breath - Voice changes, spasms of the voice box, inflammation of the bronchi - Stridor, wheezing, and blocking of the small air passages in the lungs - Bleeding in the airway, fluid buildup in the lungs, congestion, or collapsed lung. 4. Ingestion exposure: - Burns in the mouth, esophagus, and stomach - Difficulty swallowing - Nausea, vomiting, diarrhea, and severe abdominal pain - Gastritis, vomiting of blood, black, tarry stools, potential hole in the stomach. 5. Neuromuscular symptoms: - Disorders related to the nervous and muscular systems - Changes in calcium and potassium levels interfering with electric signal transmission in neurons - Signs can range from anxiety and confusion to seizures, paralysis, or coma. It is important to note that the severity of these signs and symptoms can vary depending on the concentration of the acid, duration of exposure, and whether any protective measures were taken. Immediate medical evaluation is necessary to assess and treat any life-threatening issues.

Hydrofluoric acid burns can occur through skin exposure, eye exposure, inhalation exposure, or ingestion exposure.

The doctor needs to rule out the following conditions when diagnosing Hydrofluoric Acid Burns: 1. Imbalances in calcium, potassium, and magnesium levels in the body. 2. Abnormal heart rhythms, such as QT prolongation, peaked T waves, or arrhythmias. 3. Lung issues, such as pulmonary edema or pneumonitis. 4. Kidney problems, such as renal dysfunction, insufficiency, or renal cortical necrosis. 5. Chemical burns. 6. Chlorine toxicity. 7. Fluoride toxicity. 8. Burns or injuries to the eyes caused by chemicals.

The types of tests needed for Hydrofluoric Acid Burns include: 1. Blood tests to check for imbalances in calcium, potassium, and magnesium levels. 2. Electrocardiograms (EKG or ECG) to monitor the heart's electrical activity and identify any irregularities. 3. Chest X-ray to check for potential lung issues such as pulmonary edema or pneumonitis. 4. Monitoring of EtCO2 levels to check the amount of carbon dioxide being breathed out. 5. Urinalysis to check for kidney problems such as renal dysfunction, insufficiency, and renal cortical necrosis. 6. Regular measurement of blood fluoride, potassium, and calcium levels for severe burns. 7. In some situations, dialysis might be required for fluoride removal and to correct excessive potassium and calcium levels.

Hydrofluoric Acid burns are treated by rinsing the affected area thoroughly with either cold or warm running water or saline for at least 30 minutes. After rinsing, a neutralizing agent such as calcium gluconate should be applied multiple times to mitigate the damage caused by fluoride ions. For eye exposures, rinsing with large amounts of cool plain water or sterile saline solution for 15-30 minutes is recommended, followed by treating with a 1% calcium gluconate solution or other appropriate treatments. In the case of inhalation exposure, treatment could include providing 100% oxygen and a calcium gluconate nebulized solution. Severe burns require urgent medical attention and careful monitoring, with burns greater than four square inches needing immediate intensive care monitoring. Regular measurement of blood fluoride, potassium, and calcium levels is necessary, and dialysis might be required in some situations for fluoride removal and to correct excessive potassium and calcium levels.

When treating Hydrofluoric Acid Burns, there can be several side effects. These include: - Severe burns that require urgent medical attention and careful monitoring. - Burns greater than four square inches need immediate intensive care monitoring. - Individuals who have been exposed to hydrofluoric acid gas should also be monitored in an intensive care unit. - Regular measurement of blood fluoride, potassium, and calcium levels is necessary. - In some situations, dialysis might be required for fluoride removal and to correct excessive potassium and calcium levels.

A dermatologist or a burn specialist.

Chemical Burns Electrocardiogram Toxic Exposure Wilderness and Environmental X-ray