Hydrofluoric acid burns from a household rust remover

To the Editor: The report by Mangion et al1 draws attention to a serious risk in the environment. The general public has been increasingly protected against the risk of harm from domestic products by a combination of legal liability actions and government regulation. Thus, the continuing availability to the general public of hydrofluoric acid (HF) in concentrations that are hazardous is something of an anachronism.

While we applaud Mangion and colleagues for raising the issue of HF burns, we feel that their article is deficient in failing to mention a number of important points.

• Topical calcium gluconate has been shown to be more effective in treating HF burns if the preparation contains dimethyl sulfoxide (DMSO).2

• There is a great risk of blindness with ocular exposure to HF.

• Slow local injection with 10% calcium gluconate using fine needles, titrating its effect against the patient's pain, is a well described technique. This is another treatment option that could have been tried.

• Nail removal, described by Mangion et al as an "extreme measure", is, unfortunately, often required. It is less likely to be required with the application of DMSO/calcium gluconate solution and retrograde ischaemic intravenous injection of calcium.

• Local excision of contaminated tissue may be required after exposure to concentrated solutions.

• Management should be a team effort from the first moment, involving an intensivist/toxicologist and surgeon, as burns surgeons are trained in the care of HF exposure, and surgery is often needed.

The availability, packaging, and labelling of preparations containing HF have recently been changed. Since 1 December 2001 it has no longer been possible for the general public to purchase any HF preparation stronger than 1%. All preparations now carry prominent labelling drawing attention to the risk of blindness if even dilute solutions of HF get into the eyes. Containers are now less easy to open by children.

These changes have been introduced by the National Drugs and Poisoning Committee of the Therapeutic Goods Administration as a result of an independent review and lobbying by the Australian and New Zealand Burn Association (ANZBA).

The ANZBA guidelines for referral to a specialised burns unit include chemical burns. The peculiar challenge posed by HF burns emphasises the need for the guidelines to be more widely disseminated. Currently, the New South Wales Department of Health has adopted the guidelines, so this policy is official throughout New South Wales.