Hydrofluoric acid (HF) exposure
Hydrofluoric acid (aqueous hydrogen fluoride) is used in the glass, metal and semiconductor industries. Unlike typical strong acids, HF causes both local corrosive injury and systemic fluoride toxicity.
Small or apparently minor skin exposures can produce severe, deep tissue destruction and life‑threatening hypocalcaemia, hypomagnesaemia, hyperkalaemia, metabolic acidosis and arrhythmia. Rapid decontamination, early antidotal calcium and timely specialist escalation are central to emergency management (UKHSA; GOV.UK; RCEM/NPIS).
Clinical features
- Local: severe, often disproportionate pain; erythema, blistering and necrosis.
- Deep tissue liquefaction may be substantially greater than visible surface damage.
- Systemic: perioral/limb paraesthesia, muscle cramps, tetany, hypotension, syncope and cardiac arrhythmias.
- Inhalation: airway irritation, bronchospasm and pulmonary injury.
- Important: serum fluoride levels may lag behind clinical toxicity - do not wait for these to start treatment.
Initial priorities on arrival
- Ensure personal/scene safety: use appropriate PPE and decontamination facilities before patient contact.
- Remove contaminated clothing and jewellery immediately.
- Copious irrigation with water without delay - remove contaminated material and irrigate continuously while arranging further care.
- Primary survey (ABCs). Anticipate airway involvement after inhalation exposure.
- Early notifications: contact burns/plastics, toxicology/NPIS and critical care/vascular teams as indicated.