Treatment of Hydrogen Fluoride Inhalation Poisoning
Immediate administration of 100% oxygen via non-rebreather mask and nebulized 2.5-5% calcium gluconate solution is the cornerstone of treatment for hydrogen fluoride inhalation poisoning. 1
Immediate Management
- Remove the victim from exposure area immediately while ensuring rescuer safety through proper personal protective equipment (PPE) including NIOSH/MSHA-approved respirators, splash-proof goggles, neoprene gloves, and acid-proof clothing 1
- Administer 100% oxygen via non-rebreather mask to support respiratory function and help eliminate absorbed hydrogen fluoride 1
- Establish airway management and consider early intubation if signs of upper airway edema or respiratory distress are present 1
- Perform thorough decontamination by removing contaminated clothing and washing affected skin areas immediately with copious amounts of water 1, 2
Specific Antidote Therapy
- Administer nebulized 2.5-5% calcium gluconate solution for inhalation exposure as the primary antidote treatment 1
- Monitor and manage serum calcium and magnesium levels, as profound hypocalcemia and hypomagnesemia are common complications 3
- Calcium gluconate therapy has become the preferred method of detoxifying the fluoride ion by binding free fluoride ions in the tissues 4
- For severe cases, consider intravenous calcium gluconate administration to counteract systemic fluoride toxicity 2
Monitoring and Supportive Care
- Monitor vital signs, cardiac rhythm, and respiratory status continuously 1
- Watch for signs of acute respiratory distress syndrome, which can develop rapidly after significant inhalation exposure 1
- Monitor for cardiac arrhythmias, which may occur due to electrolyte disturbances, particularly hypocalcemia 1, 3
- Assess acid-base status and provide correction as needed 5
Cautions and Pitfalls
- Delayed recognition of exposure can lead to fatal outcomes - symptoms may appear with delay even after exposure to low concentrations 1, 2
- Do not underestimate the severity of exposure based on initial presentation, as systemic toxicity can develop rapidly 2
- Healthcare providers must wear appropriate PPE during decontamination and treatment to prevent secondary exposure 1
- The pain intensity may not correlate with the severity of tissue damage, potentially leading to underestimation of injury 2
Prognosis
- Fatal outcomes are typically associated with extensive exposure or delayed treatment initiation 1
- Severe inhalation exposure can lead to acute respiratory distress syndrome and cardiac arrhythmias 1
- Even exposure to low-concentrated solutions or gases may provoke delayed systemic disorders with potentially lethal outcomes 2
Hydrogen fluoride is a protoplasmic poison with extremely harmful systemic effects through any route of exposure, including inhalation 6. The clinical course can develop with alarming rapidity, making immediate intervention crucial 5. The combination of respiratory support with 100% oxygen and calcium gluconate as a specific antidote forms the foundation of treatment, while close monitoring and management of electrolyte disturbances are essential to prevent fatal complications.