ACUTE LUNG INJURY IN A WORKER AFTER INHALATION OF ETHYLENE PHOSPHORODIFLUORIDITE

Abstract

TOPIC: Disaster Medicine TYPE: Global Case Reports INTRODUCTION: Ethylene phosphorodifluoridite (1,2-bis-difluorophosphanyloxy-ethane) [CAS# 3965-00-2](C2H4F4O2P2) is a colorless, corrosive fuming liquid that is water-soluble (3.9 g/100 ml water), and adopted as an electrolyte stabilizer in rechargeable batteries. There are no previous reports of the toxic effects of ethylene phosphorodifluoridite inhalation. In this report, we describe a patient who developed acute lung injury after accidental inhalation of ethylene phosphorodifluoridite. CASE PRESENTATION: We describe a 28-year-old male who complained of respiratory distress after accidental inhalation of ethylene phosphorus difluoride for 30 min. The patient developed acute lung injury with non-cardiogenic pulmonary edema and was treated with supportive management. The patient fully recovered and was discharged after 7 days without any significant sequelae. DISCUSSION: This case report has several toxicological implications. First, many new industrial chemicals with unknown toxicity, such as ethylene phosphorodifluoridite, are produced and used at workplaces due to the rapid development of the materials industry. Caution should be exercised to prevent acute lung injury due to inhalation of unknown chemical compounds that include phosphorus and fluorine. Second, it is important to consider that inhaled toxic chemicals, such as ethylene phosphorodifluoridite, may lead to significant pulmonary disease even if the initial symptoms are mild. Therefore, patients should be monitored closely regardless of initial symptoms. A limitation of this case report is that we were unable to estimate the amount of ethylene phosphorodifluoridite that the patient inhaled. CONCLUSIONS: This case highlights the importance of safety when using ethylene phosphorodifluoridite, which was recently introduced for use in rechargeable batteries due to the rapid development of the materials industry. Inhaled ethylene phosphorodifluoridite may cause acute lung injury with non-cardiogenic pulmonary edema. Supportive management with oxygen led to complete clinical recovery of the patient described here. However, further studies should be performed to confirm the relationship between inhalation of ethylene phosphorodifluoridite and non-cardiogenic pulmonary edema. REFERENCE #1: McKay CA, Jr. Toxin-induced respiratory distress. Emerg Med Clin North Am. 2014 Feb;32(1):127-47. REFERENCE #2: Jegal Y, Kim Y. Industrial chemicals and acute lung injury with a focus on exposure scenarios. Curr Respir Med Rev. 2016;12(1):44-55. REFERENCE #3: Akira M, Suganuma N. Acute and subacute chemical-induced lung injuries: HRCT findings. Eur J Radiol. 2014 Aug;83(8):1461-9. DISCLOSURES: No relevant relationships by Yangho Kim, source=Web Response No relevant relationships by Woon Jung Kwon, source=Admin input No relevant relationships by jimi oh, source=Web Response No relevant relationships by Seung Won Ra, source=Web Response