Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2019; 7(20): 3341-3346
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3341
Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report
He Fang, Guang-Yi Wang, Xun Wang, Fang He, Jian-Dong Su
He Fang, Guang-Yi Wang, Department of Burn Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai 200433, China
Xun Wang, Fang He, Jian-Dong Su, Department of Burn and Plastic Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215002, Jiangsu Province, China
Author contributions: Fang H, Wang GY, Wang X, and He F contributed equally to this manuscript; Wang X was the patient’s surgeon, reviewed the literature, and contributed to manuscript drafting; Wang GY and Fang H reviewed the literature and contributed to manuscript drafting; He F analyzed and interpreted the imaging findings; Su JD reviewed the literature and drafted and revised the manuscript; all authors issued final approval for the version to be submitted.
Supported by the National Nature Science Foundation of China, No. 81701899 and No. 81671911; Youth Incubation Plan of the Military Medical Science and Technology, No. 16QNP091; Naval Medical University Youth Start-up Fund, No. 2016QN10; the Logistics Scientific Research Program, No. AWS14C001-4; Jiangsu Provincial Health Commission Project, No. H2017071; Suzhou Clinical Medical Center Construction Program, No. SZZXJ201506.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Dong Su, MD, PhD, Assistant Professor, Doctor, Surgeon, Department of Burn and Plastic Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, 242 Guangji Road, Suzhou 215002, Jiangsu Province, China. jiandongsu@njmu.edu.cn
Telephone: +86-18006133889 Fax: +86-21-57643271
Received: April 18, 2019
Peer-review started: April 18, 2019
First decision: August 1, 2019
Revised: September 4, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 26, 2019
Processing time: 191 Days and 19.1 Hours
Abstract
BACKGROUND

Hydrofluoric acid (HF) is one of the most common causes of chemical burns. HF burns can cause wounds that deepen and progress aggressively. As a result, HF burns are often severe even if they involve a small area of the skin. Published cases of HF burns have mostly reported small HF burn areas. Few cases of HF inhalation injury have been reported to date.

CASE SUMMARY

A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60% of the total body surface area (TBSA), including deep second degree burns on 47% and third degree burns on 13% of the TBSA, after he fell into a pickling pool containing 15% HF. Comprehensive treatments were carried out after the patient was admitted. Ventricular fibrillation occurred 9 times within the first 2 h, and the lowest serum Ca2+ concentration was 0.192 mmol/L. A dose of calcium gluconate (37 g) was intravenously supplied during the first 24 h, and the total amount of calcium gluconate supplementation was 343 g. Extracorporeal membrane oxygenation (ECMO) was applied for 8 d to handle the acute respiratory distress syndrome (ARDS) induced by the HF inhalation injury. The patient was discharged after 99 d of comprehensive treatment, including skin grafting.

CONCLUSION

Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS. Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.

Keywords: Hydrofluoric acid burn; Inhalation injury; Hypocalcemia; Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Case report

Core tip: Hydrofluoric acid (HF) is one of the most common causes of chemical burns. We present a case of extensive HF burns combined with inhalation injury and review the related literature. The patient had extensive HF burns covering 60% of the total body surface area. A dose of calcium gluconate (37 g) was intravenously supplied in the first 24 hours, and the total amount of calcium gluconate supplementation was 343 g. Extracorporeal membrane oxygenation was applied to handle the acute respiratory distress syndrome induced by the HF inhalation injury. We believe that our report makes a significant contribution to the literature.