Hydrofluoric Acid Burns: Rational Treatment

Abstract

I commend the message underlying the article by Stuke et al.1 An interest in extravasation injuries2 preceded my interest in hydrofluoric acid (HF) burns. Many years ago, I was asked to see a renal patient who had had an intravenous extravasation of 10% calcium gluconate, a hyperosmolar agent that causes devastating tissue destruction. Subsequently, I was referred my first case of HF burn affecting the right (dominant) hand of a glass worker. I was presented with a patient with a tense swollen thenar eminence by a pleased looking emergency physician holding a 5-ml syringe and a half empty vial of 10% calcium gluconate. It was with extreme alarm that I decompressed the thenar eminence with hyaluronidase. The dismayed doctor showed his manual that described subcutaneous infiltration with 10% calcium gluconate for hand HF burns. This stimulated the most extensive and intellectually rigorous review of the published literature pertaining to HF burn and their management.3 We also developed a series of algorithms for treating cutaneous, inhalation, ingestion, and eye burns involving HF.4 It is interesting to note that the management we recommended in 1995 is the one supported by the clinical experience of the Parkland Memorial team. Another published algorithm for HF burns appeared in an article from Brisbane.5 This detailed a series of algorithms based on supposed clinical experience and the “novel” use of dimethyl sulfoxide, although we had discussed this fully in our previous review.3 Our commentary to that article points out other fundamental and misleading statements regarding HF burns.6 I have had to express caution about the dangers of intraarterial infusion following reports in other journals, including The Journal of Burn Care and Rehabilitation.7,8