Objective: To investigate the clinical characteristics of patients with
hydrofluoric acid (HF)
burns. Methods: Clinical data of 316 patients with HF
burns admitted to Zhejiang Quhua Hospital from January 2004 to December 2016 were retrospectively analyzed. Patients were divided into non and mild
poisoning group (NMP, n=157), moderate
poisoning group (MP, n=120), and severe and fatal
poisoning group (
SFP, n=39) based on the severity of
poisoning. Occurrences of
hypocalcemia, hypomagnesemia,
hypokalemia, and
hyperkalemia of patients within 24 hours after admission were recorded. Values of emergency urinary
fluoride of patients on admission were recorded. Values of urinary
fluoride of patients admitted to hospital in 4 hours post injury in groups MP and
SFP at post injury hour 4, 12, and 24 and on post injury day 2, 3, 4, 5, 6, and 7 were also recorded. Electrocardiographic abnormalities of patients within 24 hours after admission were recorded. Data were processed with chi-square test, Kruskal-Wallis H test, and Mann-Whitney U test. Results: (1)
Hypocalcemia, hypomagnesemia, and
hypokalemia occurred in some patients in each of the three groups, but no patient had
hyperkalemia. Taking serum
calcium namely total serum
calcium as reference, the incidence rate of
hypocalcemia of patients in group NMP was close to that in group MP (χ(2)=0.05, P>0.05). The incidence rate of
hypocalcemia of patients in group
SFP was significantly higher than that in group NMP or group MP (χ(2)=10.53, 7.92, P<0.01). The incidence rates of
hypokalemia in the three groups were close (χ(2)=0.63, P>0.05). Taking serum ionized
calcium as reference, the incidence ratio of
hypocalcemia of patients in group NMP was close to that in group MP (χ(2)=0.01, P>0.05), while there were statistically significant differences in incidence ratio of
hypocalcemia of patients between group
SFP and each of group NMP and group MP (χ(2)=4.66, 4.47, P<0.05). Taking serum
calcium as reference, the incidence rate of
hypocalcemia of patients was 7.3% (23/316). Taking serum ionized
calcium as reference, the incidence rate of
hypocalcemia of patients was 60.0% (42/70), which was significantly higher than that of taking serum
calcium as reference (χ(2)=113.74, P<0.01). The incidence rates of hypomagnesemia of patients in groups MP and NMP were close (χ(2)=0.02, P>0.05). The incidence rate of hypomagnesemia of patients in group
SFP was significantly higher than that in group NMP or group MP (χ(2)=14.69, 9.94, P<0.01). (2) The urinary
fluoride levels were tested in 288 patients, with the value of emergency urinary
fluoride of patients on admission 0.2-590.0 mg/L. The values of urinary
fluoride of 202 patients were above the normal value. The values of emergency urinary
fluoride of patients in groups NMP, MP, and
SFP were 2.15 (1.11, 4.30), 5.89 (1.72, 14.25), and 36.0 (13.2, 103.2) mg/L, respectively. The values of emergency urinary
fluoride of patients in groups MP and
SFP were significantly higher than the value in group NMP (χ(2)=23.28, 66.03, P<0.01). The value of emergency urinary
fluoride of patients in group
SFP was significantly higher than that in group MP (χ(2)=39.23, P<0.01). The value of urinary
fluoride of 33 patients admitted to hospital within 4 hours post injury in groups MP and
SFP reached the top at 4 hours post injury and then gradually declined, which returned to normal on about 5 days post injury. The values of urinary
fluoride of patients in group
SFP at 4, 12, and 24 hours post injury and on 2, 3, 4, 5, 6, and 7 days post injury were significantly higher than those in group MP (Z=-4.28, -4.15, -3.81, -4.21, -2.48, -2.06, -2.31, -2.68, -3.03, P<0.05 or P<0.01). (3) Twenty-seven patients had electrocardiographic abnormality. There were 12 patients with T wave changes (the most common), 8 patients with ST-T changes, 6 patients with ventricular arrhythmias, 6 patients with conduction block, and 1 patient with broadened QRS waveform. There was no patient with prolonged Q-T interval. The ratios of patients with the above electrocardiographic abnormalities in group
SFP were higher than those in group NMP and group MP. Conclusions: Clinical manifestations of patients with HF
burn are
hypocalcemia, hypomagnesemia,
hypokalemia, and electrocardiographic abnormality. In addition to routine serum
electrolyte and electrocardiogram monitoring, the levels of serum ionized
calcium and urinary
fluoride can be helpful to evaluate the severity of illness of the patients.