Integrated Management of Multisite Corrosive Injuries Following Hydrogen Fluoride Gas Exposure

ABSTRACT

A man in his 30s sustained multisite corrosive injuries and possible inhalational exposure after an accident involving hydrogen fluoride gas. Prehospital irrigation and Hexafluorine decontamination were followed by hospital‐based topical calcium therapy, staged ocular and cutaneous care, and goal‐directed systemic calcium and magnesium supplementation titrated to ionized calcium. Despite prominent pain and decreased ionized calcium, arterial oxygenation and thoracic imaging remained normal, supporting a dynamic evaluation–de‐escalation approach to airway management. Multidisciplinary coordination enabled timely decontamination, electrolyte control, infection risk mitigation, and wound healing. The patient recovered without arrhythmia or hypoxemia and was discharged for outpatient care. This case underscores the clinical value of early decontamination, dynamic electrolyte monitoring, and protocolized teamwork in hydrogen fluoride toxicity.

Key Clinical Message

Early decontamination, topical and systemic calcium–magnesium therapy, and dynamic ionized calcium monitoring are vital in hydrogen fluoride toxicity. Normal oxygenation and imaging justify airway de‐escalation. Multidisciplinary, protocolized management optimizes wound healing, prevents arrhythmia, and avoids overtreatment in multisite corrosive injuries.

Integrated analysis of facial burn severity, chest CT abnormalities, and dynamic changes in serological markers among severe burn patients.

1. Background

Hydrogen fluoride is a highly corrosive agent used in chemical and metal processing. Exposure may produce delayed local and systemic toxicity, including corrosive skin and ocular injury, inhalational irritation, and electrolyte disturbances such as hypocalcemia and hypomagnesemia that predispose to cardiac arrhythmia [1]. Timely decontamination, titrated systemic calcium replacement guided by ionized calcium, and coordinated multidisciplinary care are central to reducing morbidity. This report illustrates a structured emergency–critical care pathway emphasizing dynamic assessment and evidence‐based de‐escalation when pulmonary involvement is not demonstrated.

2. Case Presentation

A man in his 30s was exposed to hydrogen fluoride gas during an industrial incident, with splashes to the face, left eye, right upper limb, and right thigh, and immediate inhalational irritation. Coworkers initiated copious water irrigation and applied Hexafluorine prior to transfer to the emergency department. On arrival, he reported severe pain and foreign‐body sensation in the left eye. Examination showed left conjunctival congestion and grayish necrotic lesions over the face, right arm, and thigh (Figure 1). Vital signs were stable. Relevant history was non‐contributory and there were no chronic comorbidities documented. Laboratory tests (Table 1) showed leukocytosis and decreased ionized calcium despite normal or mildly fluctuating total calcium. Arterial oxygen saturation and blood gases were unremarkable. Chest computed tomography showed no acute abnormality (Figure 2). Working diagnoses included hydrogen fluoride poisoning with ocular, facial, and limb corrosive injuries; acute gastric mucosal irritation; and electrolyte disturbance with hypocalcemia.

FIGURE 1.

Facial burn image.

TABLE 1.

Serological indicators.

Index	Day 1	Day 2	Day 3	Day 4	Day 6	Day 8
WBC (×109/L)	17.18	18.87	12.48	/	9.25	/
PaO2/FiO2	439	433	467	382	/	252
K+ (mmol/L)	4.1	4.19	4.77	4.2	4.36	4.7
Ionized calcium (mmol/L)	1.13	0.98	0.97	0.92	/	1.06
Total calcium (mmol/L)	2.52	2.21	2.38	/	2.32	2.15
P (mmol/L)	/	1.36	1.25	1.37	1.17	1.04
Mg (mmol/L)	/	/	0.6	/	0.78	0.67

FIGURE 2.

Chest CT imaging.

3. Investigations

Initial laboratory evaluation revealed leukocytosis and reduced ionized calcium with relatively preserved total calcium. Serial ionized calcium and electrolytes were monitored to guide therapy. Baseline electrocardiography was performed for arrhythmia surveillance and remained without malignant rhythms. Pulse oximetry and arterial blood gases showed normal oxygenation. Chest computed tomography did not reveal inhalational injury. These findings supported targeted electrolyte correction while maintaining vigilance for evolving respiratory compromise.

4. Differential Diagnosis

Key considerations included: (1) hydrogen fluoride–induced systemic toxicity with hypocalcemia and hypomagnesemia predisposing to arrhythmia; (2) chemical pneumonitis due to inhalational exposure; and (3) superimposed soft‐tissue infection of corrosive wounds. Normal oxygenation and unimpaired thoracic imaging argued against clinically significant chemical pneumonitis at presentation, though close observation was maintained. Clinical surveillance and wound assessments were used to discriminate colonization from infection to avoid unnecessary antimicrobial exposure.

5. Treatment

5.1. Decontamination and Local Wound Care

After admission, the wound was irrigated once daily with Hexafluorine, followed by topical application of 14% calcium gluconate gel. Local therapy was staged according to eschar evolution, with sequential use of recombinant bovine basic fibroblast growth factor, polymyxin B compound ointment, and fusidic acid cream as clinically indicated.

5.2. Ocular Management

The left eye was irrigated once daily with Hexafluorine, then received antibacterial drops, a short course of corticosteroid therapy, and epidermal growth factor eye drops, with slit‐lamp follow‐up.

5.3. Systemic Therapy

Intravenous supplementation with 2% calcium was titrated by adjusting the infusion rate to maintain ionized calcium within the low‐normal range. Magnesium supplementation was provided to stabilize membrane potentials and mitigate arrhythmia risk. Supportive therapy included intravenous fluids and pantoprazole for gastric protection. Empirical meropenem was initiated for deep, multisite corrosion wounds and later tailored to clinical evolution.

5.4. Respiratory Care

Nebulized budesonide was started early to reduce airway inflammation and discontinued when serial assessments confirmed normal oxygenation and negative imaging.

6. Outcome and Follow‐Up

Electrolytes remained stable with goal‐directed supplementation. No arrhythmias or hypoxemia occurred during hospitalization. Pulmonary imaging remained normal. The patient was discharged in good condition for outpatient wound care. At short‐term follow‐up, facial and limb wounds were dry with partial scab detachment, and there were no respiratory complaints.

7. Discussion

Fluoride ions chelate calcium and magnesium, producing systemic ionic toxicity and potentially life‐threatening arrhythmias [2, 3]. Accordingly, dynamic monitoring of ionized calcium is critical, as total calcium may remain deceptively normal [4]. Inhalational hydrogen fluoride exposure can cause chemical pneumonitis [5]; however, when oxygenation, blood gases, and chest imaging are normal, a dynamic evaluation–de‐escalation approach to airway therapy is appropriate. In this case, early decontamination, titrated calcium/magnesium replacement, and staged local and ocular care achieved pain control, limited tissue injury, and prevented arrhythmia. A protocolized, team‐based pathway—incorporating immediate ECG and electrolyte monitoring; goal‐directed supplementation; continuous wound irrigation; staged ocular and cutaneous management; and evidence‐guided respiratory de‐escalation—can streamline care and reduce overtreatment. While outcomes were favorable, generalizability is limited by single‐case design; larger series are warranted to validate integrated protocols for hydrogen fluoride toxicity.

8. Learning Points/Take‐Home Messages

• Prioritize immediate decontamination and topical calcium therapy for hydrogen fluoride exposures.

• Use dynamic ionized calcium monitoring to titrate intravenous calcium and magnesium, as total calcium may be misleading

• Adopt a dynamic evaluation–de‐escalation approach to airway management when oxygenation and imaging are normal.

• Stage ocular and cutaneous wound care to promote epithelial repair while minimizing infection risk.

• Coordinate multidisciplinary care to expedite interventions and avoid overtreatment.

9. Patient's Perspective

“I felt severe pain and burning right after the accident. The eye drops and dressings helped quickly. The team checked my blood frequently and explained why calcium treatment was important. I was relieved that my breathing stayed normal and that I could recover at home after discharge.” (Edited for clarity and anonymity.)

Written informed consent was obtained from the patient for publication of this case report and accompanying images in accordance with the journal's guidelines.

Author Contributions

Huang Zhaolue: investigation, writing – original draft, writing – review and editing. Luo Jishen: conceptualization, resources. Yang Minghao: data curation, supervision. Pan Xianfeng: project administration.

Funding

The authors have nothing to report.

Consent

The patient provided written informed consent to allow for his de‐identified medical information to be used in this publication.

Conflicts of Interest

The authors declare no conflicts of interest.

Zhaolue H., Jishen L., Minghao Y., and Xianfeng P., “Integrated Management of Multisite Corrosive Injuries Following Hydrogen Fluoride Gas Exposure,” Clinical Case Reports 14, no. 2 (2026): e72046, 10.1002/ccr3.72046.

Data Availability Statement

The patient details are available in the electronic medical records and can be made available from the authors on request.