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Hydrofluoric Acid Burn A

B

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45-year-old healthy man was involved in demolishing an indus- Martin W. Dünser, M.D. trial plant in which glass had been etched. He was exposed to a reservoir of Josef Rieder, M.D. 70% hydrofluoric acid while repairing a pipeline. He was admitted to the Medical University of Innsbruck intensive care unit for second-degree and third-degree burns from hydrofluoric acid A-6020 Innsbruck, Austria RETAKE 1st AUTHOR Duenser ICM affecting 30% of his body-surface area,REGincluding both hands, both forearms,2nd the [email protected] F FIGURE a&b 3rd chest, back, scalp, and neck. After penetrating tissue, hydrofluoric acid dissociates CASE TITLE Revised EMail into hydrogen and fluoride ions, of which particularly fluoride is toxic. Line 4-C Since fluoride SIZE Enon ARTIST: mst H/Tand magnesium, H/T ions are inactivated by means of precipitation with calcium the 39p6 FILL Combo infusion of calcium and magnesium is considered a therapy in patients with hydroAUTHOR, PLEASE NOTE: fluoric acid burns. In this patient, magnesium was intravenously, and calcium Figure has infused been redrawn and type has been reset. Please check carefully. was infused intravenously and intraarterially (through the brachial artery) and was applied topically to the burned skin. TheJOB: blood magnesium level ISSUE: was always within 35506 2-8-07 the normal range during substitution therapy. Blood levels of ionized calcium were initially elevated to up to 1.75 mmol per liter but were within the normal range after 36 to 48 hours. As a result of this intense calcium and magnesium therapy, cutaneous calcification developed on the fingertips by 36 to 48 hours, as well as on the dorsal and palmar aspects of the hand (Panels A and B, respectively). Three months later, the patient had regained an almost full range of motion, was free of symptoms, and had a good aesthetic result. Copyright © 2007 Massachusetts Medical Society.

n engl j med 356;6  www.nejm.org  february 8, 2007

The New England Journal of Medicine Downloaded from nejm.org on September 12, 2014. For personal use only. No other uses without permission. Copyright © 2007 Massachusetts Medical Society. All rights reserved.

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