[A fatal case of acute occupational organic fluoride inhalation poisoning]

Organic fluoride compounds are a class of chemical raw materials containing fluorocarbon bonds, primarily classified into fluorinated alkanes and fluorinated olefins. Short-term high-concentration inhalation can lead to acute lung injury, acute respiratory distress syndrome (ARDS), and rapidly progressive pulmonary fibrosis, with persistently high clinical mortality rates. This study summarizes the clinical characteristics, treatment experience, and prognostic factors of acute occupational inhalation poisoning by mixed organic fluoride gases to provide reference for similar case management. A retrospective analysis was conducted on the occupational exposure history, clinical diagnosis and treatment process, and outcome data of a patient who inhaled a mixture of hexafluoropropylene and tetrafluoroethylene in a sealed, non-ventilated warehouse. The patient developed irritative dry cough and progressive dyspnea after toxin exposure. Despite symptomatic supportive treatment at another hospital, the condition continued to deteriorate, leading to admission to our hospital on 9 days post-exposure. Upon admission, the oxygenation index was 123.1 mmHg, and chest CT revealed diffuse reticular and honeycomb-like density enhancement in both lungs, confirming a diagnosis of acute severe organic fluoride poisoning with moderate ARDS. Comprehensive interventions including high-dose glucocorticoid pulse therapy, invasive mechanical ventilation, anti-infection measures, alveolar lavage, and veno-venous extracorporeal membrane oxygenation (VV-ECMO) were administered, yet the patient's condition continued to worsen. The patient ultimately died from respiratory and circulatory failure due to severe pulmonary fibrosis complicated by spontaneous pneumothorax. Acute organic fluoride poisoning has a poor prognosis, necessitating emphasis on early identification, adequate and prolonged corticosteroid therapy, and prompt initiation of ECMO support. Concurrently, occupational safety and health education in workplaces should be strengthened to reduce disease risk at the source.