氫氟酸集體中毒事件報告

An Outbreak of Hydrofluoric Acid Burn

楊振昌(Chen-Chang Yang) ； 楊冠洋(Guang-Yang Yang) ； 鄧昭芳(Jou-Fang Deng)

《中華職業醫學雜誌》 3卷1期 (1996/01) Pp. 1-8

https://doi.org/10.30027/CJOM.199601.0001

摘要

氫氟酸（HF）為一無色略帶刺激味的無機酸，普遍地被使用於各種工業，如半導體工業及金屬除銹等。然而，因氫氟酸之酸性遠較其他強酸為低，在低濃度暴露時，可能遲至24小時才產生明顯症狀；也因而常導致患者中毒而不自知，並因延誤治療或治療錯誤而產生嚴重的病症，甚至於死亡。吾人在此僅報告一件因誤用氫氟酸導致集體中毒，並因延誤治療產生後遺症的案例。希望藉以提醒醫療人員對於氫氟酸中毒的認識，並冀以提供良好的醫療照護。
某工廠共23名員工為清除遭電焊渣污染的變壓器，而使用不知名的除銹溶液。其中有2名員工，在事後因患部疼痛而至臺北榮民總醫院就診，並因游離血鈣降低及臨床症狀，判定為疑似氫氟酸中毒，而接受靜脈注射及局部葡萄糖鈣治療。事後經現場訪視及問卷調查發現，在17名可追蹤的員工中；所有人在暴露不等時間後（15分鐘至3小時），皆產生患部疼痛及其他程度不一之化學性灼傷，並有5人產生指甲脫落或變黑等後遺症。17名員工除2外，多未接受鈣製劑或鎂製劑之治療。所使用的溶液經事後查證，確認為氫氟酸。
殌氟酸中毒的個案在臺灣並不少見，而近來更有逐年增多的趨勢。氫氟酸由於具有良好的除銹功能，且刺激性較低；因此使用者，常因欠缺警覺心，未作好防護工作，而導致意外中毒。氫氟酸中毒除可造成局部傷害外，因低血鈣而導致抽搐、心律不整則是可能致死的原因。對於氫氟酸中毒的治療，主要可使用局部葡萄糖鈣，或注射含鈣及鎂的製劑。對於低血鈣的治療，則有賴及時的鈣離子補充，才可避免因低血鈣而衛生的危險。然而，唯有充份地認識氫氟酸的特性與正確地使用，才是預防與治療氫氟酸中毒最佳的方法。

關鍵字

氫氟酸灼傷 ； 低血鈣 ； 葡萄糖鈣

並列摘要

Hydrofluoric acid (HF), a colorless inorganic acid with mild irritating odor, is used extensively in various industries, such as the semiconductor industry and the electropolishing of metal. As it is a weak acid compared to other acid halides, symptoms of hydrofluoric acid burn are less immediately irritating and may be delayed as late as 24 hours after exposure. Such insidious manner of presentation may therefore go unnoticed for hours, leading to untimely diagnosis and severe morbidity. HF burns are not uncommon in Taiwan and more than 55 cases can be documented in the 5 years duration of PCC operation. As HF is an excellent agent for removing rust and is less irritating than other acids, without precaution, workers are amenable to the development of HF burn after exposure. We herein report an outbreak of accidental HF burn, wishing that the medical personnel may better understand the potential hazards of HF exposure.
A total of 23 workers were exposed to an unlabelled rust removing agent after an intention to clean the soldering dust-stained transformers. Two workers came to the Veterans General Hospital-Taipei 2 days after exposure presenting excruciating pain over the exposed digits. On admission, HF burn was suspected by the low serum free calcium and the clinical features. The pain was almost immediately ameliorated by intravenous as well as topical calcium gluconate. A walk-through survey was then conducted and related information was gathered from17 exposed workers (74%) by questionnaires. All of these 17 workers experienced intense pain after various intervals of exposure (15 min to 3h). However, none, except 2 workers, received the administration of calcium or magnesium salts after exposure and 5 workers eventually developed sequelae. The rust removing agent was later confirmed to be HF.
In addition to local destructive process and hypocalcemia as shown by this incident, HF burn may be fatal through through hypocalcemia induced cardiac arrhythmia. Treatment for HF burns thus include not only local and parenteral administration of calcium or magnesium salts, but also careful management of hypocalcemia which require close monitoring and timely intravenous infusion of calcium gluconate. Nevertheless to say, prevention and the proper use of HF remain the cornerstone in the treatment of HF burns.

並列關鍵字

Hydrofluoric acid burns ； hypocalcemia ； calcium gluconate