Zhang Tongyue, He Xingbing, Wang Chen, Zhou Zhiqiang, Genjiafu Aerbusili, Wen Zixin, Jian Xiangdong, Li Qilu
Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Emergency Medicine, Ankang Central Hospital, Ankang, Shanxi, China.
Front Med (Lausanne). 2024 Oct 30;11:1342212. doi: 10.3389/fmed.2024.1342212. eCollection 2024.
Hydrofluoric and nitric acids are strongly acidic substances with strong oxidation and are widely used in industrial production. Chemical pneumonia caused by the inhalation of strong acids has occasionally been reported. Severe chemical pneumonia can lead to acute pulmonary edema and life-threatening acute respiratory distress syndrome. The treatment of chemical pneumonia mainly relies on symptomatic and supportive treatment such as anti-inflammatory and anti-infection.
This study reports three cases of chemical pneumonia caused by the inhalation of a mixed hydrofluoric and nitric acid mist during an occupational exposure accident. After appropriate emergency symptomatic treatment, such as oxygenation and excretion promotion, cough, and difficulty in breathing were alleviated but not completely cleared.
Most of the literature reports damage caused by hydrogen fluoride on the skin and mucosal burns, and reports on lung damage caused by the inhalation of large amounts of hydrogen fluoride gas are relatively rare. Usually in the early stage of this kind of patients can have elevated blood picture, hypoxemia, pulmonary CT inflammatory plaque changes, so as to have obvious respiratory irritation symptoms. When inhaling a large amount of hydrofluorine mixed nitric acid mist, in addition to considering the occurrence of severe pneumonia, we should also be alert to the occurrence of other organ damage and electrolyte disorder.
As occupational hydrogen fluoride gas inhalation poisoning often occurs in groups, improving the safety facilities and standard operations of small- and medium-sized enterprises is necessary. For medical workers, it is necessary to be alert to the occurrence of severe toxic pneumonia and severe fluorosis.
氢氟酸和硝酸是具有强氧化性的强酸物质，在工业生产中广泛使用。偶尔有因吸入强酸导致化学性肺炎的报道。严重的化学性肺炎可导致急性肺水肿和危及生命的急性呼吸窘迫综合征。化学性肺炎的治疗主要依靠抗炎、抗感染等对症支持治疗。
本研究报告了3例职业暴露事故中因吸入氢氟酸和硝酸混合雾导致的化学性肺炎病例。经过适当的紧急对症治疗，如给氧、促进排泄等，咳嗽、呼吸困难症状有所缓解但未完全消除。
大部分文献报道氟化氢对皮肤和黏膜的损伤，关于吸入大量氟化氢气体导致肺部损伤的报道相对较少。这类患者早期通常可出现血常规升高、低氧血症、肺部CT有炎性斑片改变，从而出现明显的呼吸道刺激症状。吸入大量氢氟混合硝酸雾时，除考虑发生重症肺炎外，还应警惕其他器官损伤及电解质紊乱的发生。
由于职业性氟化氢气体吸入中毒常呈群体性发生，完善中小企业的安全设施及规范操作很有必要。对于医务人员来说，有必要警惕重症中毒性肺炎及重症氟病的发生。
