Episode 53- An expert talks: Hydrofluoric acid exposures


 

Episode Summary:

This week we discuss hydrofluoric acid exposures with Dr. KC Lee, a clinical pharmacist with training in toxicology/ emergency medicine

Show Notes:

Key Points:

“An expert talks: Hydrofluoric acid exposures”:
– Hydrofluoric acid (HF) is a dermal/ respiratory irritant and a weak acid (dissociation constant is ~1,000 times less than HCl). Toxicity is caused by the the highly reactive F- ion
– HF penetrates tissues deeply, where the F- ion is released and destroys cells. Unlike other acids which are rapidly neutralized, HF may continue its destruction for days if left untreated
– F- precipitates with divalent cations- causing hypocalcemia and hypomagnesemia, as well as hyperkalemia due to extracellular shifting. Caution using succinylcholine for rapid sequence intubation in these patients given this risk of hyperkalemia
– One of the most toxic effects of the F- ion is its reaction with calcium (Ca). The basis for treatment of exposures is Ca, given by numerous different methods/routes to precipitate the F- ion:
– Systemic: use your institution’s electrolyte replacement protocol to aggressively replace Ca (consider also replacing magnesium)
– Ophthalmic: irrigate the eyes thoroughly with normal saline (NS) or lactated ringer’s (useful as it contains Ca). This is one scenario where it is not recommended to directly apply Ca salts, as they can cause corrosive injury to the eye
– Inhalation: use nebulized calcium gluconate (CaGluc) at a 2.5-5% concentration. A 2.5% solution can be made by mixing 1 part 10% CaGluc solution : 3 parts sterile water (SW)/NS. For example, take 1 mL of CaGluc + 3 mL of NS/SW and place this into the neb chamber
– Subcutaneous: although rarely used, consider using a 5-10 % CaGluc solution and injecting with a 27-30 gauge needle around the affected area. Use a maximum of 0.5 mL per digit or 1 mL/ cm^2
– Intra-arterial: may be useful for burns involving several digits or subungual areas, or if topical therapy fails. Dilute 10 mL of 10% CaGluc (avoid calcium chloride) with 50 mL D5W and infuse over 4 hours through brachial or radial artery catheter
– Topical: the most common route of administration. If hand or fingers are affected, place the Ca solutions in a surgical glove over the hand with continuous massaging and frequent gel application. If you do not have the commercially-available gel (Calgonate), compound a 2.5% gel by mixing 1 g 10% CaGluc + 40 mL Surgilube/KY Jelly. Another method is to crush 20 calcium carbonate (TUMS) tablets (200 mg elemental Ca per tab) and adding to 5 oz of Surgilube/KY Jelly
– With the topical route, local anesthetics should not be used since they mask pain, which is an important sign of treatment adequacy
ER-Rx Episode 53

Please click HERE to leave a review of the podcast!


Leave a Reply

Your email address will not be published. Required fields are marked *

Recent Reviews/ Comments

“I love listening to this podcast because I can listen to 1 or 2 on my way to work and it provides great info! As a paramedic, this podcast has really helped me understand the “why” we give certain meds.”

cresjr, Apple Podcasts review

“Ideal podcast to listen on the way to my shift. Learning points throughout!”

andmatjos, Apple Podcasts review

“I’m currently in my last year of pharmacy school […] I just happen to come across your podcast on YouTube as I was trying to find a good explanation regarding the misleading sulfa allergy in non-antibiotic sulfonamides. Your explanation was great. I can’t believe I’m only now finding out about your podcasts but please continue to make them for as long as you can. Prospective pharmacists, such as myself, really appreciate you taking the time to put such great educational content out there.”

– S.P., Pharmacy Student

“Adis does a wonderful job of gathering the evidence-based answers to the hard questions that we all get as pharmacists and putting them into a nice, neat package.”

– rebroush1, Apple Podcasts review

“This is a great podcast to listen to at work and is not too overwhelming and well put together. Highly recommended for anyone in healthcare, even outside of emergency medicine.”

Peelage, Apple Podcasts review

“Great reviews on drug-related topics with useful details on drug mechanisms, pharmacodynamics and administration considerations as well as data to support recommendations. Great for pharmacists, providers and learners!”

-JaayyZzee, Apple Podcasts review

“I found the topics very helpful. I have been recommending this show to pharmacy students and residents, who are also enjoying it.”

hvgjnfd, Apple Podcasts review

“As a PA, I found this very informative. I like that the episodes are short, making them easy to listen to on my way to and from work. Would love to hear more pediatric topics!”

-Pediatric PA, Apple Podcasts review

“Good podcast thats very informative for all healthcare providers. Very easy to listen to and enjoy.”

-Bradlley88, Apple Podcasts review