Acids

28YOM PRESENTS TO ED FOR HAND INJURY. PT HAS ACID BURN TO RT HAND JUST PRIOR TO ARRIVAL TODAY. PT WAS ATTEMPTING TO MAKE SKIN CARE PRODUCTS AT HOME AND ATTEMPTING A CHEMICAL REACTION INVOLVING SULFURIC ACID. WHEN REACTION DIDNT APPEAR TO BE PROCEEDING, PT ATTEMPTED TO STIR MIXED CREATION CAUSING SUDDEN BOIL OVER ONTO UNGLOVED RT HAND. IMMEDIATE BURNING PAIN TO DORSUM OF RT HAND. DX: BURN

30 YOM REPORTS AN ACID SPILLED ON MY FOOT A WEEK AGO, AND I PUT WATER ON IT, AND IT STARTED BURNING. DX: NO DX, LEFT WITHOUT BEING SEEN.

51YOM STATES HE WAS SPRAYING ACID ON SOME BRICKS OUTSIDE AND THE WIND BLEW THE ACID INTO HIS EYES, DX EYE PROBLEM

50YOM PRESENTS WITH SHORTNESS OF BREATH, DIFFICULTY SWALLOWING AND CHANGE IN VOICE AFTER INHALATION EXPOSURE OF MURIATIC ACID. PATIENT RINSED FACE AND NOSTRILS. DX: ACUTE COUGH, PNEUMONITIS, CHEMICAL PNEUMONITIS

71YOM STATES THAT HE WAS CLEANING AN ALUMINUM TANK AT HOME AND WAS SPRAYING THE TANK WITH ALUMINUM ACID CLEANER WHEN THE CLEANER LEAKED ONTO HIS HAND NOW HAS A BURNING SENSATION DX: CHEMICAL EXPOSURE

48YOM WAS FOUND IN HIS LIVING QUARTERS WITH A SIGNIFICANT AMOUNT OF BLOOD SPLATTERED AROUND HIS LIVING QUARTERS, REPORTS HE HIT HIS HEAD, AHS DRIED BLOOD IN HIS HAIR, ALSO STATES THAT HE HAS DIFFICULTY BREATHING AFTER A STRANGER WITH SOME SMALL CHILDREN WHO THEN EXPOSED HIM TO SOME HYDROCHLORIC ACID. DX: SYMPTOMATIC ANEMIA

37YOM, C/O WOUND MIDDLE FINGER X 2 WEEKS, GOT CLEANING ACID ON HIS HANDS, NOT WEARING GLOVES DX: NO DIAGNOSIS, ELOPEMENT

65YOM P/W HAND PAIN, PT STATES HE ACCIDENTALLY DIPPED HI HAND IN A LIQUID HE BELIEVES WAS ACID, PT REPORTS NO BLISTERS OR OPENED WOUNDS, 2DX:HAND PAIN, PERIPHERAL NEUROPATHY

75YOF PRESENTS WITH RIGHT EYE PAIN, DRAINAGE AND SWELLING SINCE YESTERDAY. PATIENT STATES SHE ACCIDENTALLY PUT 2 DROPS OF SULFURIC ACID IN HER EYE THINKING IT WAS LUBRICATING DROPS. SHE HAD IMMEDIATE BURNING AND FLUSHED HER EYE FOR 15 MINUTES WITH TAP WATER. THIS MORNING SHE HAS GREEN DRAINAGE FROM THE EYE, UNABLE TO SEE OUT OF EYE AND EYE IS SWOLLEN SHUT. DX: ULCER CORNEA RIGHT.

31 YOF WITH LEFT EYE PAIN. PT WEARS CONTACTS AND ACCIDENTALLY SOAKED THEM IN AN ACID SOLUTION INSTEAD OF CONTACT LENSE CLEANER. DX CORNEAL ABRASION

40 YOM WAS USING HYDROCHLORIC AND HYDROFLUORIC ACID 2 DAYS AGO AND GOT IT ON HIS BILATERAL LOWER EXTREMITIES, UNKNOWN CIRCUMSTANCES. DX: CHEMICAL BURN

30YOM PATIENT COMPLAINING OF LEFT EYE PAIN AFTER ACID FELL IN MY EYES COUPLE DAYS AGO, AND IT'S HURTING NOW . DX: ACID CHEMICAL BURN OF LEFT EYE

The Carolinas Poison Center was contacted regarding a patient who was exposed to JBI Inc. (76 Palmetto Industrial Park, Timmonsville, SC 29161, P: (843)346-4996) “Dull Buster” Hydrofluoric acid wheel cleaning solution purchased one week prior from a local Car Quest. The specific hydrofluoric acid percentage is not listed on the bottle. A “warning UN # 1790” was listed on the bottle which corresponds to Hydrofluoric acid “with not more than 60 % hydrofluoric acid.” A specific MSDS sheet was delayed in availability (the company states a chemtrek phone number is present on the bottle, however, this number is not visible in any pictures of the labels sent to poison center). Also, the specific instructions present on the label do not appear to adequately capture the potential dangers of hydrofluoric acid exposure. They state that after skin exposure, one should “Flush with water. Remove contaminated clothing.” It does not state that skin/inhalation exposure can be potentially life threatening. It also does not state that care should be sought for inhalation/skin exposure. There are various potential therapeutic options that would be available such as the administration of calcium gluconate. Encouraging consumers to seek care could also ensure proper follow up with a hand surgeon when appropriate to prevent further morbidity. Also, the product lists “rubber gloves” as appropriate protection for the use of this product. Latex gloves would not be adequate and further guidance on appropriate protection is not listed. The patient in question was transported to a higher level of care and treated with invasive procedures that carry serious risks. The decision regarding transfer and to perform these procedures would have been better informed if the product were properly labeled. The Carolinas Poison Center discussed this case with the director of the UNC Burn Center as well as the North Carolina Department of Health and Human Services. All involved parties involved are i