Abstract
Case: A 34-year-old male fell into a hydrochloric acid tank at a chemical factory during work without any witnesses. His whole body had been immersed in hydrochloric acid (approximately 35% concentration in a tank measuring 2m in depth) for about 10 minutes (maximum estimated time interval) and then was transferred to the hospital in 18 minutes after he had fallen into the tank. On arrival he was lucid, spoke clearly and was moderately hyperventilated. Transnasal intubation was performed prophylactically to avoid any airway obstruction due to subsequent swelling. An initial examination of the arterial blood gas (ABG) showed pH 6.76, PaCO2 26.3 mmHg, PaO2 268 mmHg, BE −27.8 mmol/l, lactate 124 mg/dl, P50 98 mmHg, which indicated severe lactate acidosis and abnormally elevated P50. He was given 250 ml of sodium bicarbonate in order to correct this severe metabolic acidosis (pH < 7.0) and the following ABG showed pH 7.111, PaCO2 33.7 mmHg, PaO2 492 mmHg, BE −17.4 mmol/l, lactate 107 mg/dl, P50 34 mmHg, which indicated a remarkable improvement of P50 and PaO2. His condition worsened and he died 2 days after presentation due to total body deep chemical burns. Conclusion: This is the first report of such a severe metabolic acidosis with hyperlactatemia and an abnormal elevation of P50 due to total body emersion in concentrated hydrochloric acid case, which is considered to have resulted in the massive absorption of hydrochloric acid through the systemic skin, thus contributing to the aggravation of toxic symptoms.
