1/16. burns caused by dilute hydrofluoric acid in the bleach.Two male cleaning workers aged 62 (patient 1) and 28-(patient 2) presented with red, swollen, aching hands and fingers. At the first interview, the fingers of the right hand of both patients were swollen from the proximal interphalangeal joint to the tip of the finger. The fingers were red and intensely painful. The bleach that both patients used contained 9.5% hydrofluoric acid, and therefore we diagnosed their symptoms as those of burns caused by this agent. We subcutaneously injected 8.5% calcium gluconate into the affected fingers and dressed them with gauze soaked in cooled 0.025% benzethonium chloride. The patients did not use gloves at work, neither of them knew that the cleaning fluid contained dilute hydrofluoric acid, and they were unaware of the danger of this agent. They had not received proper education about the care and handling of poisons and deleterious substances such as hydrofluoric acid. The doctors who had examined the patients in the emergency ward overlooked the possibility of hydrofluoric acid burns, although they suspected chemical burns and confirmed the trade name of the cleaning agent. In addition, although the patients presented with intense pain, no white areas of coagulation and blistering, or surrounding erythemas, which are characteristic symptoms of such burns, were evident. The component of the cleaning agent was described on the container label in very small print. Had the words "poison" and "hydrogen fluoride" been printed in large characters, the examining doctors in the emergency ward would probably not have overlooked the presence of hydrofluoric acid, and the patients would perhaps have been more careful when using it. hydrofluoric acid can be easily obtained by anyone through the internet, although general consumers could not obtain industrial quantities. Therefore, the number of burn patients who are not familiar with hydrofluoric acid may increase in the future.- - - - - - - - - - ranking = 1keywords = fluoride (Clic here for more details about this article) |
2/16. Ocular hydrofluoric acid burns.A 30-year-old man sustained exposure of his eyes, face, and neck involving 4% of body surface area to hydrofluoric acid. He was treated with immediate lavage and topical calcium gluconate. Because free fluoride ions from ocular and facial exposures can form complexes with body stores of calcium and magnesium, the patient was transferred to a burn unit for cardiac and electrolyte monitoring. He was also treated with calcium gluconate skin injections, pulmonary nebulizer therapy, and topical antibiotics and corticosteroids. In another case, a 25-year-old man with less severe exposure to hydrofluoric acid was treated as an outpatient with topical antibiotics, corticosteroids, and cycloplegia. If an ophthalmologist is the first to treat a patient with chemical exposure, the history of hydrofluoric acid exposure must be obtained, and the burn team and other medical specialists must be quickly consulted to avoid potentially fatal complications.- - - - - - - - - - ranking = 1keywords = fluoride (Clic here for more details about this article) |
3/16. hydrofluoric acid-induced burns and life-threatening systemic poisoning--favorable outcome after hemodialysis.BACKGROUND: skin contact with hydrofluoric acid (HF) may cause serious burns and life-threatening systemic poisoning. The use of hemodialysis in fluoride intoxication after severe dermal exposure to HF has been recommended but not reported. CASE REPORT: A 46-year-old previously healthy man had 7% of his body surface exposed to 71% HE Despite prompt management, with subsequent normalization of the serum electrolytes, recurrent ventricular fibrillation occurred. On clinical suspicion of fluoride-induced cardiotoxicity, acute hemodialysis was performed. The circulatory status stabilized and the patient fully recovered. High fluoride levels in the urine and serum were confirmed by the laboratory. DISCUSSION: There is no ultimate proof that the favorable outcome in this case was significantly attributable to the dialysis. However, most reported exposures of this magnitude have resulted in fatal poisoning. As our patient had normal serum electrolytes and no hypoxia or acidosis at the time of his arrhythmias, it was decided that all efforts should be focused on removing fluoride from his blood. The rationale for performing hemodialysis for this purpose is clear, even though such intervention is more obviously indicated in patients with renal failure. CONCLUSION: Hemodialysis may be an effective and potentially lifesaving additional treatment for severe exposure to HF when standard management has proven insufficient.- - - - - - - - - - ranking = 4keywords = fluoride (Clic here for more details about this article) |
4/16. descemet membrane detachment caused by hydrogen peroxide injury.OBJECTIVE: To describe a patient who developed a descemet membrane detachment after hydrogen peroxide injury with successful reattachment by intracameral injection of sulfur hexafluoride gas. methods: Case report. RESULTS: The right eye of a 40-year-old man was exposed to 35% hydrogen peroxide. This resulted in a central corneal epithelial defect, corneal edema, a localized detachment of descemet membrane, and a gas bubble between the posterior corneal stroma and descemet membrane. The descemet membrane detachment persisted after reabsorption of the gas bubble. Successful reattachment of descemet membrane was achieved with injection of 0.15 mL of 20% sulfur hexafluoride gas into the anterior chamber. CONCLUSION: hydrogen peroxide ocular injury may cause descemet membrane detachment, and successful reattachment may be achieved with intracameral injection of 20% sulfur hexafluoride gas.- - - - - - - - - - ranking = 3keywords = fluoride (Clic here for more details about this article) |
5/16. Fatality due to acute fluoride poisoning in the workplace.We report a case of a 65-year-old worker who suffered a third-degree skin burn to 5% of his total body surface area as a result of being splashed in the face with hydrofluoric acid (HF). He died shortly thereafter without having received adequate first aid. His serum fluoride concentration was markedly increased at 6.38 mg/dl with hypocalcemia and hyperkalemia. We concluded that he died of HF poisoning. In this case he might have managed to avoid death if he had not been working alone and if he had received adequate first aid on the scene as soon as possible. We re-emphasize the need for the immediate initiation of first aid on the scene and the distribution of information on the risks of HF to workers.- - - - - - - - - - ranking = 5keywords = fluoride (Clic here for more details about this article) |
6/16. An improved method for emergent decontamination of ocular and dermal hydrofluoric acid splashes.Accidental hydrofluoric acid (HF) splashes often occur in industrial settings. HF easily penetrates into tissues by initial acid action allowing fluoride ions to penetrate deeply, chelating calcium and magnesium. Resultant hypocalcemia and hypomagnesemia can be fatal. This report describes the utilization of Hexafluorine--a hypertonic, amphoteric, chelating decontamination solution--in workplaces where water decontamination followed by calcium gluconate inunction failed to prevent HF burns and systemic toxicity. Between 1998 and 1999, 16 cases of ocular and dermal HF splashes with either 70% HF or 6% HF/15% nitric acid (HNO3) were decontaminated with Hexafluorine at the worksite. HF burns did not develop and medical treatment other than initial decontamination was not reQuired in 12/16 (75%). In 7/16 (44%) cases, lost work time corresponded to duration of hospital observation (mean < 1 d).- - - - - - - - - - ranking = 1keywords = fluoride (Clic here for more details about this article) |
7/16. Lethal inhalation exposure during maintenance operation of a hydrogen fluoride liquefying tank.calcium sulfate adheres to the inside of liquefying pipes during the production of liquefied hydrogen fluoride. It is regularly washed away with water jets every six months. Two days before the operation, the pipes were experimentally washed down with water and the safety of the operation was confirmed with acidic washing fluid (pH 5). A 65-year-old man was severely sprayed on his face just after the start of the operation. He died half an hour later from acute respiratory failure. High serum concentrations of ionized fluoride indicated massive exposure to hydrofluoric acid (HFA). Pathological findings revealed severe bilateral pulmonary congestion and edema. It was hypothesized that calcium sulfate hardened with the water during the experimental washing and caused some blockages in the pipes. Consequently, choking of the pipes caused the HFA to collect and the washing fluid ran back. Weak HFA is not pungent to skin and mucous membranes. Therefore, it was suggested that a low concentration of HFA was inhaled directly into the peripheral respiratory tracts. No risk management against HFA exposure was in place during the operation. It is especially important to take thorough safety measures against inhalation of HFA. It is also essential that there are no stoppages of the pipes before the operation.- - - - - - - - - - ranking = 6keywords = fluoride (Clic here for more details about this article) |
8/16. hydrofluoric acid-induced hypocalcemia.Among patients exposed to hydrofluoric acid the potentially lethal effect of calcium depletion induced by binding with fluoride ion has not been well reported. Three patients exposed to hydrofluoric acid had acute fluoride poisoning with serum calcium levels equal to or below 4.1 mgm/dl. Treatment included administration of large amounts of calcium, both intravenously and by subsechar injection, to replenish the biologically active calcium and to bind fluoride. This report describes successful treatment of two survivors, apparently the first two, of severe hypocalcemia caused by hydrofluoric acid.- - - - - - - - - - ranking = 3keywords = fluoride (Clic here for more details about this article) |
9/16. hydrofluoric acid burns.hydrofluoric acid burns create unique problems that require specialized treatment to prevent serious sequelae. The most important factors to remember are the delay in the onset of signs and symptoms related to concentration of acid and the penetration and destruction of tissues by fluoride ions, which bind calcium and magnesium cations with subsequent serious systemic effects. In this article, an attempt has been made to describe these factors and to offer recommended treatment protocols which, if appropriately applied, can offset the destructive nature of HF burns. Several methods of treatment have been offered, and it is recommended that one or more be used according to circumstances. The most important initial point in treatment is the recognition that an HF burn has occurred. Then, with a clear understanding of the mechanisms of injury, one can properly manage such a burn. It is hoped that this report will assist the practitioner in dealing with this potential serious and complex problem.- - - - - - - - - - ranking = 1keywords = fluoride (Clic here for more details about this article) |
10/16. Fatal hydrofluoric acid cutaneous exposure with refractory ventricular fibrillation.A patient with hydrofluoric acid burns involving only 8% of his body surface area died from intractable cardiac arrhythmia secondary to the depletion of ionized calcium by fluoride ion. For burns of this type, immediate subcutaneous injection of 10% calcium gluconate into the burn wound is recommended and the dose given should be titrated to the relief of local pain. Immediate debridgement of the burn wound also can decrease the treacherous aspect of the circulating fluoride ion, which binds to calcium to form an insoluble salt, effectively removing the calcium ion from any physiologic interaction.- - - - - - - - - - ranking = 2keywords = fluoride (Clic here for more details about this article) |
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