Hydrofluoric acid inhalation injury after electric bike battery fire

The rapid increase in electric bike (e-bike) use has led to a rise in lithium-ion battery fires, which present significant hazards. Beyond thermal injury, these fires emit toxic gases such as hydrogen fluoride (HF), capable of causing severe chemical inhalation injury. The pulmonary effects of inhaled hydrofluoric acid are not well characterised in the literature.

Two cases of severe lung injury occurred following indoor e-bike battery fires. The first patient sustained 32% total body surface area (TBSA) burns and developed acute respiratory distress syndrome with radiological evidence of chemical pneumonitis, necessitating prolonged mechanical ventilation and resulting in persistent pulmonary impairment. The second patient sustained 44% TBSA burns and experienced rapidly progressive respiratory failure that was disproportionate to typical smoke inhalation injury. Despite maximal supportive therapy, including extracorporeal membrane oxygenation, the patient died from catastrophic pulmonary failure.

Lithium-ion battery fires present both thermal and chemical hazards, especially in enclosed environments. These cases highlight the importance of maintaining a high index of suspicion for toxic inhalation injury, promptly recognising disproportionate respiratory failure, and monitoring for biochemical indicators of hydrofluoric acid exposure as the prevalence of lithium-ion battery use increases.