Finger burns caused by concentrated hydrofluoric acid, treated with intra-arterial calcium gluconate infusion: case report.
BACKGROUND
Hydrofluoric acid (HF) is widely used in industry and at home. Severe lesions can occur after contact with highly concentrated solutions, leading to tissue necrosis and bone destruction. Specific treatment is based on neutralization of fluoride ions with calcium or magnesium solutions.


METHODS
A 41-year-old male was seen at the emergency department 35 minutes after skin contact with 70% HF, showing whitened swollen lesions on the middle and fourth fingers of his right hand with severe pain starting immediately after contact. 2.5% calcium gluconate ointment was applied. Twenty-four hours later, the patient was still in severe pain and the lesions had worsened. Considering the high concentration of the solution, early start of severe pain, lesion characteristics and impossibility of administering calcium gluconate subcutaneously because of the lesion location, the radial artery was catheterized and 2% calcium gluconate was administered via infusion pump for 36 hours, until the pain subsided. No adverse effects were seen during the procedure. Ten days later, the lesions were stable, without bone abnormalities on X-rays. Six months later, a complete recovery was seen.


CONCLUSIONS
Intra-arterial calcium gluconate might be considered for finger burns caused by concentrated HF. Complete recovery of wounded fingers can be achieved with this technique even if started 24 hours after the exposure. However, controlled clinical trials are needed to confirm the effectiveness and safety of this intervention.
Poison Control Center, School of Medicine, University Hospital, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. capitani@fcm.unicamp.br
Eduardo Mello de
EM
Capitani
Elcio Shiyoti
ES
Hirano
Isabela de Souza Cortez
Ide S
Zuim
Laura
L
Bertanha
Ronan José
RJ
Vieira
Paulo Roberto
PR
Madureira
Fábio
F
Bucaretchi
D000062:Accidents, Occupational; D000328:Adult; D002057:Burns, Chemical / Q000188:drug therapy* / Q000209:etiology; D002125:Calcium Gluconate / Q000627:therapeutic use*; D005383:Finger Injuries / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D006858:Hydrofluoric Acid / Q000633:toxicity*; D007261:Infusions, Intra-Arterial / Q000379:methods / Q000592:standards; D008297:Male
D006858:Hydrofluoric Acid; D002125:Calcium Gluconate