190 Toxicology
Further Reading
3 Hydrofluoric acid burns
(i) Neutralize these as follows:
(a) convert hydrofluoric acid to the calcium salt by covering the
affected area with dressings soaked in 10% calcium gluconate
solution, or by rubbing in 2.5% calcium gluconate gel
(b) inject s.c. 10% calcium gluconate if the pain and burning
persist
(c) give i.v. regional treatment with 10% calcium gluconate
(similar to a Bier’s block technique) for an extensive limb
burn.
(ii) Dermal absorption of fluoride ions may result in systemic
fluorosis causing hypocalcaemia, hypomagnesaemia,
hyperkalaemia and cardiac arrest
(a) systemic fluorosis may follow burns affecting as little as 2–5%
of body surface area from concentrated 70% hydrofluoric
acid
(b) seek immediate senior ED doctor help, and give large
amounts of i.v. calcium chloride and magnesium sulphate as
indicated clinically, and from blood testing.
4 Refer all patients to the surgical team unless the area burnt is minimal and
the patient is pain free.
5 Refer patients with systemic f luorosis to ICU. The hyperkalaemia may
require haemodialysis.FURTHER READING
American Heart Association (2010) Part 12: Cardiac arrest in special situations:
2010 American Heart Association guidelines for cardiopulmonary resuscita-
tion and emergency cardiovascular care. Circulation 122 : S829–61.
European Resuscitation Council (2010) European Resuscitation Council
Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circum-
stances. Resuscitation 81 : 1400–33.
Murray L, Daly F, Little M, Cadogan M (2011) Toxicology Handbook, 2nd edition.
Elsevier, Sydney.
National Poisons Information Service TOXBASE®. http://www.toxbase.org/
(poisons information).
Toxinz. http://www.toxinz.com/ (toxicology first aid and management).