Hydrofluoric Acid Burn Management and Systemic Toxicity

Hydrofluoric acid (HF) is a uniquely hazardous chemical owing to its dual corrosive and systemic toxic effects. Cutaneous exposure may initially present as mild erythema and disproportionate pain, yet rapidly progress to deep tissue destruction, including subcutaneous and osseous damage. Fluoride ions penetrate cell membranes, chelate calcium and magnesium, and disrupt cellular metabolism, leading to local necrosis and life-threatening electrolyte disturbances. Systemic toxicity manifests as hypocalcaemia, hypomagnesaemia, hyperkalaemia and potential cardiac arrhythmias, with severe cases culminating in multiorgan failure. Effective management hinges on prompt decontamination with copious water irrigation, followed by targeted neutralisation using topical, intradermal or intravenous calcium formulations. Continuous monitoring of electrolytes and cardiac function guides the need for more advanced interventions such as intra-arterial calcium infusion or extracorporeal circulatory support. Occupational exposures in glass etching, semiconductor fabrication and petrochemical industries remain the predominant source of HF injuries, with domestic incidents increasingly reported due to consumer cleaning products. Recent advances have focused on refining first-aid protocols, optimising electrolyte replacement strategies and exploring novel barrier and chelating agents to mitigate dermal penetration. Interdisciplinary collaboration between emergency clinicians, toxicologists and burn specialists is pivotal to improving outcomes and preventing long-term sequelae.

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Hydrofluoric Acid Burn Management and Systemic Toxicity publication trend

The graph below shows the total number of articles in hydrofluoric acid burn management and systemic toxicity across all publications each year (not limited to Nature Index journals).

Technical terms

Hydrofluoric acid (HF): A highly corrosive solution that releases fluoride ions capable of deep tissue penetration and systemic toxicity.

Hypocalcaemia: A critical reduction in blood calcium levels due to fluoride chelation, leading to neuromuscular irritability and cardiac arrhythmias.

Transdermal absorption: The process by which substances penetrate the skin barrier and enter systemic circulation.

Calcium gluconate: A calcium salt used topically, intradermally or intravenously to neutralise free fluoride ions and restore serum calcium.

Intra-arterial infusion: Administration of therapeutic agents directly into an artery to target local tissues and enhance drug delivery.

References

1. Hydrofluoric acid burns in the western Zhejiang Province of China: a 10-year epidemiological study. Journal of Occupational Medicine and Toxicology (2016).
2. Management of Hydrofluoric Acid Burns in the Emergency Department. Cureus (2020).
3. Impact of skin temperature and intradermal pH on transdermal fluoride absorption following hydrofluoric acid exposure: An ex vivo diffusion cell study in human skin. Toxicology Letters (2025).
4. Finger burns caused by concentrated hydrofluoric acid, treated with intra-arterial calcium gluconate infusion: case report. Sao Paulo Medical Journal (2009).