Michael Sung Pil Choe1, Mi Jin Lee2, Kang Suk Seo3, Sin Kam4, Keon Yeop Kim5, Dongwook Je6, Seong Hun Kim7, Woo Young Nho8, Hong In Park9, Sujeong Shin10, Hyun Wook Ryoo11. 1. Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: michaelchoe@hanmail.net. 2. Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: emmam@knu.ac.kr. 3. Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: kssuh@knu.ac.kr. 4. Department of Preventive Medicine and Public Health, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: kamshin@knu.ac.kr. 5. Department of Preventive Medicine and Public Health, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: pmkky@knu.ac.kr. 6. Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: jdw2000@daum.net. 7. Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: junram@nate.com. 8. Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: a345em@gmail.com. 9. Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: twilgiht2002@naver.com. 10. Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea. Electronic address: drjeong79@naver.com. 11. Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: ryoo@knu.ac.kr.
Abstract
PURPOSE: To determine the long-term prevalence and characteristics of acute hydrofluoric acid (HF) exposure in 2223 patients during the first 30 months after a mass-casualty exposure, and to confirm the antidotal effect of nebulized calcium on inhalation burns caused by HF. METHODS: This observational cohort study included patients after an HF spill in the Republic of Korea on September 27, 2012; registered patients were followed until April 2015. We assessed toxic effects, distance from spill, degree of acute poisoning, and the effect of nebulized calcium in HF-exposed individuals. RESULTS: Overall, 2223 patients received emergency management or antidote therapy for 20 days. Seventy-four of 134 patients with dermal toxicity received calcium-lidocaine gel, and 368 individuals with bronchial irritation signs received calcium gluconate via nebulizer nCG. A total 377 ampoules 786 g of calcium gluconate were used in the nCG formulation. Calcium administration did not cause adverse reactions during the observation period. Long-term cohort observation showed that 120 patients (120/2233, 5.4%) returned to medical facilities for management of HF-related symptoms within 1 month; 18 persons (18/1660, 1.1%) returned 1-3 months later with chronic cough and respiratory symptoms; and 3 patients (3/1660, 0.2%) underwent medical treatment due to upper-airway toxic symptoms more than 2 years after HF exposure. CONCLUSION: Respiratory toxicity after mass exposure to an HF spill was successfully treated by calcium nebulizer. Based on our experience, detoxification processes and the amounts of antidote stocked are important when planning for future chemical disasters at the community level.
PURPOSE: To determine the long-term prevalence and characteristics of acute hydrofluoric acid (HF) exposure in 2223 patients during the first 30 months after a mass-casualty exposure, and to confirm the antidotal effect of nebulized calcium on inhalation burns caused by HF. METHODS: This observational cohort study included patients after an HF spill in the Republic of Korea on September 27, 2012; registered patients were followed until April 2015. We assessed toxic effects, distance from spill, degree of acute poisoning, and the effect of nebulized calcium in HF-exposed individuals. RESULTS: Overall, 2223 patients received emergency management or antidote therapy for 20 days. Seventy-four of 134 patients with dermal toxicity received calcium-lidocaine gel, and 368 individuals with bronchial irritation signs received calcium gluconate via nebulizer nCG. A total 377 ampoules 786 g of calcium gluconate were used in the nCG formulation. Calcium administration did not cause adverse reactions during the observation period. Long-term cohort observation showed that 120 patients (120/2233, 5.4%) returned to medical facilities for management of HF-related symptoms within 1 month; 18 persons (18/1660, 1.1%) returned 1-3 months later with chronic cough and respiratory symptoms; and 3 patients (3/1660, 0.2%) underwent medical treatment due to upper-airway toxic symptoms more than 2 years after HF exposure. CONCLUSION: Respiratory toxicity after mass exposure to an HF spill was successfully treated by calcium nebulizer. Based on our experience, detoxification processes and the amounts of antidote stocked are important when planning for future chemical disasters at the community level.