Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report
Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report
复制标题
严重氢氟酸烧伤合并吸入性损伤导致潜在致命的电解质失衡：病例报告
DOI：
10.12998/wjcc.v7.i20.3341
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发表时间：
2019-10-26
影响因子：
1.1
通讯作者：
Su, Jian-Dong
中科院分区：
文献类型：
--
作者：
Fang, He;Wang, Guang-Yi;Su, Jian-Dong
背景技术氢氟酸(HF)是化学烧伤的最常见原因之一。高频烧伤会导致伤口加深并严重恶化。因此，即使只涉及一小块皮肤，高频烧伤也往往很严重。已发表的高频烧伤病例大多报道了较小的高频烧伤面积。迄今为止，HF 吸入性损伤的病例报道很少。病例概要 一名 24 岁男子因跌入含 15% 氢氟酸的酸洗池中，造成大面积氢氟酸烧伤，覆盖全身表面积 (TBSA) 的 60%，其中 47% 为深二度烧伤，13% 为三度烧伤。患者入院后进行综合治疗。最初2 h内心室颤动发生9次，最低血清Ca2+浓度为0.192 mmol/L。前24 h静脉补注一剂葡萄糖酸钙（37 g），补充葡萄糖酸钙总量为343 g。采用体外膜肺氧合（ECMO）治疗8 d，治疗HF吸入性损伤引起的急性呼吸窘迫综合征（ARDS）。经过99天的包括植皮在内的综合治疗后，患者出院。结论 大面积高频烧伤加上吸入性损伤可导致潜在致命的电解质失衡和急性呼吸窘迫综合征 (ARDS)。充足、及时的补钙和ECMO的应用是患者治疗成功的关键。
BACKGROUND Hydrofluoric acid (HF) is one of the most common causes of chemical burns. HF burns can cause wounds that deepen and progress aggressively. As a result, HF burns are often severe even if they involve a small area of the skin. Published cases of HF burns have mostly reported small HF burn areas. Few cases of HF inhalation injury have been reported to date. CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60% of the total body surface area (TBSA), including deep second degree burns on 47% and third degree burns on 13% of the TBSA, after he fell into a pickling pool containing 15% HF. Comprehensive treatments were carried out after the patient was admitted. Ventricular fibrillation occurred 9 times within the first 2 h, and the lowest serum Ca2+ concentration was 0.192 mmol/L. A dose of calcium gluconate (37 g) was intravenously supplied during the first 24 h, and the total amount of calcium gluconate supplementation was 343 g. Extracorporeal membrane oxygenation (ECMO) was applied for 8 d to handle the acute respiratory distress syndrome (ARDS) induced by the HF inhalation injury. The patient was discharged after 99 d of comprehensive treatment, including skin grafting. CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS. Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.