Hydrofluoric acid burns of the hand have been treated successfully with repeated application of an occlusive glove over topical calcium carbonate gel. A burn dressing then is applied along with calcium gluconate 2.5% gel or magnesium sulfate paste. Vesicles and bullae should be debrided carefully, with removal of necrotic tissue if periungual or ungual tissues are involved, the nail should be split to the base.
Calcium gluconate solution is prepared by mixing 10% calcium gluconate with an equal amount of saline to form a 5% solution and is infiltrated with a small needle in multiple injections (0.5 mL/cm 2 of tissue) into and 5 mm beyond the affected area. If the hydrogen fluoride concentration is 20% or more, if the patient has been exposed to a long delay of a lower concentration, or if a large tissue area has been affected by a lower concentration, then calcium gluconate solution should be used. The cancer risk was not increased among cohorts of chemical manufacturing workers exposed to hydrogen chloride and nitric acid.įor hydrofluoric acid burns, the definitive treatment is aimed at deactivation of the fluoride ion in tissue with calcium, magnesium, or quaternary ammonium solution. IARC finds that hydrochloric acid is not classifiable in terms of carcinogenicity to humans (group 3). An increase in the number of sister-chromatid exchanges has been found in lymphocytes of workers exposed to acid aerosols at a phosphate fertilizer factory. National Institute for Occupational Safety and Health (NIOSH) recommends that chromic acid be regulated as a carcinogen. Airborne hexavalent chromium exposure results in an increased risk of lung cancer among chromium platers. For chromic acid, IARC concludes that there is sufficient evidence of carcinogenicity in humans and animals (group 1). Battery manufacturers and steel workers exposed to mineral acid mists have an increased risk of upper aerodigestive tract cancer. The International Agency for Research on Cancer (IARC) concludes that there is sufficient evidence that occupational exposure to strong inorganic acid mists containing sulfuric acid is carcinogenic (group 1). Studies of workers exposed to sulfuric acid mists show an excess risk of laryngeal and nasopharyngeal cancer. In these cases, postmortem electron microscopy of lung tissue suggests increased permeability as a result of microvascular injury. Rapidly progressive pulmonary edema of delayed onset may follow the inhalation of fumes from accidental nitric acid exposure. For nitric acid exposure with oxides of nitrogen, overexposure tends to produce delayed symptoms 1–24 hours after inhalation, beginning with dyspnea followed by pulmonary edema and cyanosis. Noncardiogenic pulmonary edema has been reported following acute inhalation exposure to sulfuric acid fumes, with almost complete recovery except for slightly decreased diffusion capacity on pulmonary function testing. Inhalation of acid vapors or mists generally causes immediate symptoms because of high water solubility in mucous membranes, but respiratory effects may be delayed for several hours. High concentrations may cause shortness of breath, chest tightness, pulmonary edema, and death from respiratory failure. Inhalation of vapors or mists causes immediate rhinorrhea, throat burning, cough, burning eyes, and conjunctival irritation.
CHEMICAL USED TO CLEAN PRINTPRESS PENETRATES SKIN SKIN
The fluoride ion also may bind body calcium, causing life-threatening systemic hypocalcemia after acute skin exposure or osteosclerotic bone changes after chronic exposure to hydrogen fluoride mist. The intense pain that may accompany hydrogen fluoride burns is attributed to the calcium-precipitating property of the fluoride ion, which produces immobilization of tissue calcium and an excess of potassium that stimulates nerve endings.
Hydrofluoric acid, one of the most corrosive of the inorganic acids, readily penetrates the skin and travels to deep tissue layers, causing liquefaction necrosis of soft tissues and decalcification and corrosion of bone.
The extent of direct skin damage depends on the concentration of acid and length of exposure, whereas the damage to the respiratory tract by inhalation of acid mists will depend in addition on particle size. Both inorganic and organic acids, by virtue of their water solubility and acid dissociation, will cause direct destruction of body tissue, including mucous membranes and skin.
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