Hydrogen fluoride toxicity

Background

• Hydrogen fluoride (HF) is a byproduct of standard fire suppression systems.

Clinical Features

• Exposure to HF may result in rapidly progressive or fatal respiratory failure despite minimal external evidence of injury.
• Symptoms include shortness of breath, cough, or hypoxia; there must be a high level of suspicion for HF inhalation.

Differential Diagnosis

Burns

• Smoke inhalation injury (airway compromise)
• Chemical injury
  • Acrolein
  • Hydrochloric acid
  • Tuolene diisocyanate
  • Nitrogen dioxide
• Systemic chemical injury
  • Carbon monoxide toxicity
  • Cyanide toxicity
• Specific types of burns
  • Caustic burns
    • Airbag-related burns
    • Tar burn
    • Cement burn
  • Electrical injuries
    • Lightning Injuries
• Associated toxicities
  • Carbon monoxide toxicity
  • Cyanide toxicity
  • Hydrogen fluoride toxicity

Management

• Treatment is supportive.
  • If hypocalcemia is present, administer nebulized calcium gluconate (1.5 ml of 10% calcium gluconate in 4.5 ml water) q4hr until normalization of serum calcium levels.
  • In the absence of significant burns, consider steroids if symptoms do not improve.

Complications

• Bronchopneumonia can develop within a week.

See Also

• Burns