Chemical burn caused by high-concentration hydrofluoric acid: a case that followed a lethal course

Chemical burns from Hydrofluoric Acid (HFA) are poorly recognized, even though we sometimes encounter patients affected by these burns. HFA can cause lethal arrhythmia due to hypocalcemia and hypomagnesemia, particularly in cases of high-concentration HFA exposure. A 57-year-old man received lower body injuries from splashes of 50% HFA solution by an accident. He was transferred to our hospital by a helicopter emergency medical service (Doctor Heli). 10 mL of calcium gluconate solution (8.5% calcium gluconate) had been already administered before arrival to the emergency room. However, hypocalcemia was prolonged, fatal arrhythmia appeared, and we started the continuous administration of calcium gluconate. We amputated his leg in order to prevent systemic spreading of HFA. Further, we administered a massive transfusion of saline with catecholamine for the treatment of shock. However, the patient died after 7 hrs. In many reported cases of exposure to high-concentration HFA, death from fatal arrhythmia occurred within 1hr. Our patient was able to survive for 7 hrs, perhaps because of the early and intensive administration of calcium formulation and intensive care. This case serves as a warning to persons handling HFA, emergency physicians and dermatologists, who should recognize the corrosive nature and the potential risks of HFA to avoid tragic outcomes.