Application of calcium nebulization for mass exposure to an accidental hydrofluoric acid spill.

Michael Sung Pil Choe, Mi Jin Lee, Kang Suk Seo, Sin Kam, Keon Yeop Kim, Dongwook Je, Seong Hun Kim, Woo Young Nho, Hong In Park, Sujeong Shin, Hyun Wook Ryoo

Journal: Burns : journal of the International Society for Burn Injuries 2021;46(6):1337-1346

PMID: 32209280

Full Text on Elsevier Science View on PubMed

Abstract

PURPOSE

To determine the long-term prevalence and characteristics of acute hydrofluoric acid (HF) exposure in 2223 patients during the first 30 months after a mass-casualty exposure, and to confirm the antidotal effect of nebulized calcium on inhalation burns caused by HF.

METHODS

This observational cohort study included patients after an HF spill in the Republic of Korea on September 27, 2012; registered patients were followed until April 2015. We assessed toxic effects, distance from spill, degree of acute poisoning, and the effect of nebulized calcium in HF-exposed individuals.

RESULTS

Overall, 2223 patients received emergency management or antidote therapy for 20 days. Seventy-four of 134 patients with dermal toxicity received calcium-lidocaine gel, and 368 individuals with bronchial irritation signs received calcium gluconate via nebulizer nCG. A total 377 ampoules 786 g of calcium gluconate were used in the nCG formulation. Calcium administration did not cause adverse reactions during the observation period. Long-term cohort observation showed that 120 patients (120/2233, 5.4%) returned to medical facilities for management of HF-related symptoms within 1 month; 18 persons (18/1660, 1.1%) returned 1-3 months later with chronic cough and respiratory symptoms; and 3 patients (3/1660, 0.2%) underwent medical treatment due to upper-airway toxic symptoms more than 2 years after HF exposure.

CONCLUSION

Respiratory toxicity after mass exposure to an HF spill was successfully treated by calcium nebulizer. Based on our experience, detoxification processes and the amounts of antidote stocked are important when planning for future chemical disasters at the community level.

Address: Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: [email protected].; Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: [email protected].; Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: [email protected].; Department of Preventive Medicine and Public Health, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: [email protected].; Department of Preventive Medicine and Public Health, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: [email protected].; Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: [email protected].; Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: [email protected].; Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: [email protected].; Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: [email protected].; Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: [email protected].; Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: [email protected].

DOI: 10.1016/j.burns.2020.02.015

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MeSH Terms: Administration, Cutaneous, Administration, Inhalation, Adolescent, Adult, Aged, Anesthetics, Local, Antidotes, Burns, Chemical, Burns, Inhalation, Calcium, Calcium Gluconate, Chemical Hazard Release, Child, Child, Preschool, Cohort Studies, Female, Gels, Humans, Hydrofluoric Acid, Infant, Infant, Newborn, Inhalation Exposure, Lidocaine, Male, Mass Casualty Incidents, Middle Aged, Nebulizers and Vaporizers, Republic of Korea, Young Adult