To investigate the clinical effectiveness and safety of regional intravenous perfusion of calcium gluconate for treatment of hydrofluoric acid burns in fingers.

A total of 40 patients with finger hydrofluoric acid burns who met the inclusion and exclusion criteria were admitted to the Department of Burns and Wound Repair, Zhejiang Quhua Hospital from May 2018 to June 2022. Collected the general clinical data of the patients, including the distribution of injured fingers, the area and depth of wounds, the mass fraction of injured hydrofluoric acid, the time of continuous exposure to hydrofluoric acid, and the pre-hospital time. All patients were treated with regional intravenous infusion of calcium gluconate, with an infusion solution of 15 ml of 100 g/L calcium gluconate solution, 35 ml of physiological saline, and 0.1 ml of heparin sodium. The wounds were thoroughly debrided, the affected nails were removed, and routine dressing changes were performed once a day. Recorded the serum total calcium, free calcium, serum potassium, serum magnesium, blood fluoride, urine fluoride, and electrocardiogram of the patients at admission. Visual analog scale (VAS) was used to evaluate the degree of pain before perfusion, immediately after perfusion, 4 and 24 h after perfusion. Recorded the serum total calcium, free calcium, urinary fluoride, and 24-hour blood fluoride levels of patients after perfusion. Counted the adverse reactions during the perfusion and within 24 h after perfusion, as well as the healing of burn wounds.

(1) The patients included 32 males and 8 females, with majority aged 30 to 50 years (24 patients). The company were mainly non-fluorine chemical enterprises. There were 35 patients with single hand burns and 5 patients with double hand burns, and 83 fingers were involved. The total burn area was below 1% of the total body surface area (TBSA). The depth of burn was Ⅱ to Ⅳ degrees, the majority depth was Ⅱ degrees (30 patients). The hydrofluoric acid mass fraction was known in only 18 patients. The time of continuous exposure to hydrofluoric acid was 30.0(14.3, 48.8)min, and the pre-hospital time was 9.0(3.3, 19.0)h. (2) After single regional intravenous perfusion of calcium gluconate, the pain of all patients was significantly relieved. The pain score progressively decreased compared among before perfusion, immediately after perfusion, at 4 h and 24 h after perfusion (P<0.01). (3) When the patients were admitted to the hospital, according to the free calcium, there were 11 patients with hypocalcemia. In addition, there were 5 patients with hypokalemia. Compared with that at admission, the serum total calcium level was increased significantly at 4 h after perfusion (P<0.05); compared with 4 h after perfusion, the serum total calcium level was decreased significantly at 12 and 24 h after perfusion (P<0.01). Compared with that at admission, the free calcium was increased significantly at 4 h after perfusion (P<0.01); the free calcium level gradually decreased at 4, 12 and 24 h after perfusion (P<0.01). (4) When the patients were admitted to the hospital, there were 15 patients whose blood fluoride levels were higher than the normal value, the urine fluoride levels were all higher than the normal value. Compared with that at admission, the blood fluoride level was decreased significantly at 24 h after perfusion (P<0.01).The urine fluoride level was gradually decreased at admission and 4, 12 and 24 h after perfusion (P<0.01). (5) All patients had no adverse reactions during the perfusion process and within 24 h after perfusion. The wound healing time was 4.0-30.0 (11.1±5.9)d. Thirty-five patients healed after dressing change, and 5 patients healed after surgical treatment.

Even if the total area of hydrofluoric acid burn in fingers is below 1% TBSA, the level of blood fluoride and urine fluoride can still increase ten times after injury, with electrolyte disorder. Regional intravenous perfusion of calcium gluconate for treatment of hydrofluoric acid burns in fingers has significant clinical effectiveness, with simple operation and high safety. It can not only significantly reduce pain, but also effectively block the progressive damage of fluoride ions.