Hydrochloric Acid Chemical Burns: Pathophysiology and Treatment
Immediate Decontamination (First 3 Minutes Critical)
Begin copious water irrigation immediately—within 3 minutes of exposure—as this single intervention significantly reduces full-thickness burns, hospital days, and delayed complications compared to delayed irrigation. 1
Initial Steps (in order of priority):
- Remove all contaminated clothing, shoes, and jewelry immediately to prevent the acid from being trapped against the skin and causing deeper injury 1, 2
- Irrigate the affected area with large amounts of running water for at least 15 minutes minimum 1, 3
- Continue irrigation longer if pain persists, as hydrochloric acid can continue causing tissue damage 1
- Do NOT delay irrigation to search for neutralizing agents—water irrigation must begin immediately 1
The pathophysiology involves hydrochloric acid causing coagulation necrosis of tissues through protein denaturation and cellular destruction. Unlike hydrofluoric acid (which requires special antidotes), hydrochloric acid is effectively managed with water irrigation alone 4, 3.
Post-Irrigation Wound Care
After thorough decontamination:
- Cover the burn loosely with a clean, non-adherent dressing to reduce pain, protect from contamination, and limit heat loss 1
- Apply topical antibiotic ointment or petrolatum-based products to keep the wound moist and prevent drying 5, 2
- Leave blisters intact as this improves healing and reduces pain 2
- Avoid silver sulfadiazine for superficial burns, as it prolongs healing when used long-term on superficial injuries 1
Criteria Requiring Emergency Medical Attention
Seek immediate medical care if any of the following are present:
- Burns with blisters or broken skin 1
- Difficulty breathing or respiratory symptoms 1, 6
- Burns to the face, hands, feet, or genitals 1, 7
- Partial-thickness burns covering >10% body surface area (>5% in children) 1
- Full-thickness (third-degree) burns 1
- Signs of systemic toxicity including sleepiness, seizures, or vomiting 2
Hospital-Level Management
For severe hydrochloric acid burns requiring hospitalization:
- Continue irrigation if necessary upon arrival 1
- Consider early escharotomy if deep circular burns compromise circulation 1
- Initiate fluid resuscitation using the Parkland formula (2-4 mL/kg/%TBSA) for burns ≥10% TBSA in adults or ≥5% in children 8
- Monitor for compartment syndrome in circumferential burns 8
- Assess for inhalation injury if exposure occurred in enclosed spaces, checking for circumoral burns, oropharyngeal burns, and carbonaceous sputum 8, 6
Critical Pitfalls to Avoid
- Never apply ice directly to burns—this causes additional tissue damage through ischemia 2
- Never apply butter, oil, or other home remedies 1
- Never break blisters intentionally—this increases infection risk 1
- Never delay irrigation to search for specific neutralizing agents 1
Special Considerations for Hydrochloric Acid
Unlike hydrofluoric acid or phenol (which require specialized decontamination with substances other than water), hydrochloric acid is effectively managed with water irrigation alone 1, 4. However, contact your regional poison control center for confirmation if there is any uncertainty about the specific chemical involved 1, 2.
Pain Management
- Administer over-the-counter analgesics such as acetaminophen or NSAIDs for pain relief 2
- Cooling the burn site reduces pain by affecting the inflammatory cascade 2
- For severe burns requiring hospitalization, use multimodal analgesia with titrated medications based on validated pain assessment scales 5