What is replacing HF in cleaning solutions?
January 12, 2024
The following is a case discussion from the monthly toxicology national case conference.
A 66 year-old male presents with bilateral hand pain after cleaning coins with a liquid solution. Pain started one to two hours after cleaning was completed. Exam of the hand revealed bluish discoloration of middle fingernail and pale fingers with poorly demarcated discoloration of the distal fingertips.
Of course, the immediate assumption is that HF is the culprit. But the agent in the cleaning solution was actually ammonium bifloride. Due to a change in labeling recommendations for transportation of HF, ammonium bifluoride has now replaced HF in many products. It is being advertised as a safer alternative to HF.
Treatment is the same as for HF exposure. The successful treatment used in this case was calcium gluconate gel (or Tums crushed in US jelly) placed in a rubber glove and the hand then placed in the glove. ( CaCl is not used as it precipitates when mixed in most gels.) Blood was obtained for calcium, potassium and magnesium and EKG was wnl. Regional intraarterial injection of calcium may be used when the exposed area is large.
This patient was followed as an outpatient by the Burn Service.
Question prepared by Donna Seger MD
Comment: Remember that cleaning solutions can contain multiple agents. Manufactures’ labeling does not have to include all components. Material Safety Data Sheets (MSDS) list all the agents in the products, although they do use ranges. The MSDS for this cleaning agent listed ammonium bifluoride as a 2.3-10% solution. Do not use digital blocks to relieve the pain. The pain tells you that tissue necrosis is ongoing. Pain should be relieved by the treatment. ds
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Donna Seger, MD
Professor Emerita
Department of Medicine