British Columbia Drug and Poison Information Centre (BC DPIC)

Background:
Calcium gluconate 2.5% gel is used topically to manage deep tissue burns following exposure to hydrofluoric acid. Hydrofluoric acid is available commercially in rust removers, wheel cleaners, and aluminum brighteners. Local effects of exposure range from delayed-onset pain and erythema (dilute solutions) to immediate pain with skin blanching surrounded by erythema (from higher concentrations).

Approach to Management:
Treatment for topical exposure involves immediate decontamination with large volumes of water for 15-30 minutes followed by application of topical calcium gluconate gel. Calcium gluconate 2.5% gel can minimize burn injury and control pain. It should be used initially for all exposures. After flushing skin with water, massage a liberal amount of calcium gluconate gel into affected areas for a minimum of 30 minutes, and for at least 15 minutes after pain resolves. If symptoms recur, reapply a thick layer of gel and cover with dressing. For hand involvement, fill surgical glove with gel and leave on at least 4 hours. Inspect and re-dress burns every 4 hours or as required to control pain.
 
Calcium Gluconate Gel:
The commercial product, Calgonate® from Pharmascience, is not currently available. It can be extemporaneously prepared or ordered from an alternative commercial supplier.

To Prepare:
Calcium gluconate 2.5% gel may be prepared in a sterile container by mixing 10 mL of 10% calcium gluconate injectable solution (NOT calcium chloride injectable solution) with 30 mL K-Y® Jelly sterile lubricating gel. Mixing should be done rapidly while preparation is fairly liquid as viscosity will increase with time. It should thicken back into an even gel state.
Other water-based lubricants, including Taro brand gel, may be incompatible with calcium gluconate.

Alternative Product:
May be ordered from a construction supply distributor called Century Vallen:
Century Vallen Order Desk: 604-444-4121. Product Code: FAP 06645
Supplied: 2.5% gel in 25 g tube

For complete management information or the entire Hydrofluoric Acid monograph in the 5th edition of Poison Management Manual, contact 24-hr BC Poison Control  Centre.