Background: Hydrofluoric acid (HFA) toxicity can have significant morbidity and even mortality associated with seemingly small exposures. As a result of a delayed time to symptom onset, low concentration exposures may present as a diagnostic dilemma.
Objective: To demonstrate an atypical case presentation of HFA exposure, the inherent diagnostic difficulty, and subtle clues to confirming the diagnosis.
Case Report: We present the case of a 21 year old male day laborer who presented to the emergency department 12 hours after exposure to a cleaning agent used to “polish” metal with significant finger pain, minimal physical exam findings, and refractory to analgesics. He demonstrated hypocalcemia and hypomagnesemia. The patient reported symptom resolution after treatment with topical calcium gluconate.
Conclusion: This case demonstrates the importance of considering HFA toxicity in any patient who presents with pain, minimal physical exam findings, after exposure to an unknown chemical cleaning agent.Screening for the common electrolyte depletion associated with HFA toxicity may help to confirm the diagnosis as well as guide therapy.
Bassett, Robert A., "Finger Pain out of Proportion to Exam: A Case of Occult Hydrofluoric Acid Toxicity" (2015). PCOM Scholarly Papers. 1828.