Treatment of Nitric Acid Exposure on Skin
Immediately irrigate the exposed skin with copious amounts of water or sterile saline for at least 15 minutes, then apply silver sulfadiazine dressing and panthenol-containing creams to promote healing. 1, 2
Immediate Decontamination (First 2-3 Minutes Critical)
Remove all contaminated clothing immediately to prevent continued exposure and secondary contamination of healthcare providers. 1 The clothing itself can continue to release nitric acid vapor and cause ongoing tissue damage.
Brush off any powdered chemical residue with a gloved hand or cloth before irrigation to prevent further chemical reaction with water. 1
Irrigate the affected area with copious amounts of water or sterile isotonic saline for a minimum of 15 minutes. 1, 2, 3 This method has been proven as effective as specialized decontamination compounds like Fuller's Earth or sodium hypochlorite. 1
Important Caveat on Chemical Neutralization
While alkaline hypochlorite solution (0.5%) provides the most effective chemical neutralization through oxidative chlorination, it should only be used on intact skin and is contraindicated for open wounds, eye injuries, or any penetrating trauma. 1 Given that nitric acid typically causes immediate tissue destruction, water irrigation remains the safest and most practical first-line approach.
Wound Assessment and Monitoring
Look for the pathognomonic yellowish discoloration characteristic of nitric acid burns, which helps confirm the diagnosis. 2
Do not overlook deep tissue destruction beneath thick crusts on the injured area—these burns can appear deceptively superficial initially but may involve deeper structures. 3 The severity depends on concentration, duration of contact, and penetration depth of the acid. 2
Topical Treatment Protocol
Apply panthenol-containing creams to the affected area to support tissue regeneration. 2
Cover wounds with silver sulfadiazine dressing as the primary antimicrobial barrier. 2 This addresses the high infection risk in chemical burns while promoting moist wound healing.
Keep wounds clean and moist throughout the healing process—this is essential for optimal tissue repair. 2
Apply nonadherent dressings (such as Mepitel™ or Telfa™) directly to the wound bed to prevent trauma during dressing changes. 4
Use secondary absorbent dressings (such as foam or Exu-Dry™) to manage exudate if significant drainage occurs. 4
Infection Prevention and Management
Monitor carefully for signs of secondary infection including increased erythema, purulence, or systemic symptoms. 2
Administer systemic antibiotics only if clinical signs of infection develop—prophylactic antibiotics are not indicated. 4
Consider taking wound cultures from sloughy or crusted areas if infection is suspected to guide targeted antimicrobial therapy. 4
Critical Safety Considerations for Healthcare Providers
Ensure complete decontamination occurs outside the medical facility whenever possible to prevent secondary exposure of healthcare staff. 1 Even residual nitric acid on a single patient's clothing can generate sublethal vapor concentrations that disrupt hospital operations.
Healthcare providers must wear appropriate protective equipment including butyl rubber gloves (not standard latex gloves) and gas masks if treating patients with significant exposure. 1 Ordinary surgical masks and latex gloves do not provide adequate protection from toxic vapors.
Recommend patients take a complete shower after initial irrigation to avoid overlooking unaware acid injury on areas not initially identified. 3
Common Pitfalls to Avoid
- Do not delay irrigation attempting to find specific neutralizing agents—water is immediately available and highly effective. 1, 2
- Do not apply neutralizing chemicals to open wounds or damaged tissue—this can cause additional harm. 1
- Do not underestimate burn depth based on initial appearance—nitric acid can cause deep tissue destruction beneath surface crusting. 3
- Do not use topical antimicrobials prophylactically on clean wounds—reserve these for sloughy areas or confirmed infection. 4