Management of Hydrogen Fluoride Inhalation Injury

Systemic Toxicity Treatment

Intravenous calcium gluconate (10–20 mL of 10 % solution administered over 10 minutes) should be given promptly for systemic fluoride toxicity, with continuous cardiac monitoring to detect arrhythmias. 1
Topical calcium gluconate gel (2.5–5 %) is recommended for cutaneous burns caused by dermal HF exposure. 1

Serum calcium, magnesium, potassium, and arterial pH should be re‑checked every 2–4 hours in the acute phase; the presence of severe metabolic acidosis and electrolyte disturbances predicts a higher risk of poor outcomes. 1

Absence of oral lesions or pain does not exclude severe gastrointestinal or pulmonary injury; clinicians must assess systemic toxicity regardless of local symptoms. 1
Calcium replacement must not be delayed, as hypocalcemia‑induced cardiac arrhythmias can be rapidly fatal. 1
Gastric lavage or induced vomiting after HF ingestion should be avoided because these maneuvers exacerbate tissue injury. (Evidence also cited by Praxis Medical Insights, but the primary source is World Journal of Emergency Surgery.) 1
Exclusive focus on pulmonary injury without monitoring systemic toxicity is discouraged; comprehensive assessment is essential. 1

Severe metabolic acidosis, elevated lactate, leukocytosis, high C‑reactive protein, renal failure, and thrombocytopenia are associated with transmural necrosis and increased mortality. 1

Contrast‑enhanced computed tomography performed 3–6 hours after exposure is more sensitive than endoscopy for detecting transmural gastrointestinal injuries. 1

In phosgene‑related ARDS, maintain plateau airway pressure ≤30 cmH₂O and allow permissive hypercapnia provided arterial pH remains >7.20. 2