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.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
Hemodialysis may be an effective and potentially lifesaving additional treatment for severe exposure to HF when standard management has proven insufficient.
Björnhagen
V
V
Department of Reconstructive Plastic Surgery, Karolinska Hospital, Stockholm, Sweden.
Höjer
J
J
Karlson-Stiber
C
C
Seldén
A I
AI
Sundbom
M
M
D000062:Accidents, Occupational; D000287:Administration, Topical; D002057:Burns, Chemical / Q000473:pathology*; D005458:Fluoride Poisoning / Q000473:pathology / Q000628:therapy; D005459:Fluorides / Q000378:metabolism / Q000652:urine; D006801:Humans; D006858:Hydrofluoric Acid / Q000008:administration & dosage / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012867:Skin / Q000473:pathology; D014693:Ventricular Fibrillation / Q000139:chemically induced / Q000503:physiopathology; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced / Q000628:therapy
D005459:Fluorides; D006858:Hydrofluoric Acid