Hydrofluoric acid (HF), used in laboratories and in industry, causes extremely painful, rapidly penetrating skin burns. Tissue destruction may proceed under apparently intact skin. Rapid hypocalcaemia and hypomagnesaemia are features of HF toxicity, and may result in cardiac arrythmias and diffuse muscle spasm. Bone damage as a result of fluorosis is a late effect.
Inhalation of HF immediately causes laryngeal spasm and intractable cough. Pulmonary oedema and profound dyspnoea may ensue. Pulmonary fibrosis is another, irreversible, consequence.
HF ingestion is very uncommon but extremely dangerous.
Admission to Accident and Emergency is mandatory for any burn greater than 4cm2, or in the event of HF inhalation or ingestion. Calcium gluconate gel ("HF burn jelly") should be rubbed into the burn after drenching with water, and this should continue until the pain has subsided. Calcium and magnesium status require careful monitoring; admission to ITU may be necessary.
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