Hydrogen fluoride inhalation injury complicated by acute respiratory distress syndrome : A case report of successful management with venovenous extracorporeal membrane oxygenation and continuous renal replacement therapy.

RATIONALE: Hydrogen fluoride (HF) inhalation injury is a rare but life-threatening condition that can lead to chemical pneumonitis, acute respiratory distress syndrome (ARDS) and systemic fluoride poisoning. Currently, standardized treatment protocols for HF-induced ARDS are lacking and the optimal management strategy remains to be established.

PATIENT CONCERNS: A middle-aged male patient was discovered after inhaling 53% hydrogen fluoride gas and transferred to our hospital within 5 h, presenting with respiratory distress, hypoxemia and diffuse pulmonary opacities on computed tomography (CT).

DIAGNOSES: Severe HF inhalation injury, chemical pneumonitis, severe ARDS, acute kidney injury, distributive shock and systemic fluoride toxicity with hypocalcemia.

INTERVENTIONS: Urgent venovenous extracorporeal membrane oxygenation (VV-ECMO) with integrated continuous renal replacement therapy (CRRT), high-dose methylprednisolone, continuous calcium gluconate infusion, and electrolyte monitoring.

OUTCOMES: Oxygenation improved, pulmonary exudates resolved and the patient was weaned off ECMO. At 7‑month follow-up, lung lesions and renal function normalized with no long-term complications.

LESSONS: Early VV-ECMO supports oxygenation when conventional therapy fails, while CRRT aids fluoride elimination. Timely multimodal intervention is critical for HF-induced ARDS and renal failure outcomes.