Intra-arterial calcium infusion for hydrofluoric acid burns

Between March 3, 1987 and Sept. 8, 1989, intra-arterial calcium infusions were used to treat 28 patients (38 extremities) suffering hydrofluoric acid (HF) exposures that failed to respond to topical treatments. Although 18 of the injuries occurred at work, only 1 patient was using HF in a concentration greater than 12%. Many of these products were available over the counter. Most patients did not wear protective equipment and had no concept of the danger of injury from the product. Onset of symptoms (pain, erythema and edema) was delayed from 1 to 6 h after exposure. Arterial catheters were placed and the patient was begun on a protocol using 10 ml of 10% calcium chloride diluted with 40 ml normal saline and infused over a 4-h period. Each patient was allowed a 4-8 h rest period before assessing the need for additional infusions. Blood calcium, magnesium, phosphorus, PT, and PTT were monitored. Infusions were repeated until there was no tenderness. Using tenderness as an end-point increased the number of infusions compared to previous reports. The mean number of infusions was 4.1 (range, 1-10). Success (complete healing) was 100%. There was a significant rise in serum calcium, but not to dangerous levels (range 9.3-12.8). There was also a significant fall in magnesium, which reached levels requiring magnesium intravenously. There were no significant changes in phosphorus, PT, and PTT.