A case of phosphine gas inhalation after a fire incident

Phosphine (PH3) is a highly toxic gas used as a fumigant and rodenticide, and inhalational exposure can cause severe systemic toxicity. In Korea, aluminum phosphide and related compounds are strictly regulated, and PH3 poisoning has been rarely reported, with no published cases since 2012. We report a case of PH3 inhalation that occurred during post-fire cleanup at a waste treatment facility. PH3 gas was detected at the scene by the fire investigation unit, which enabled rapid diagnosis and management. The patient presented with persistent hypotension, myocardial depression, and metabolic abnormalities, which improved after norepinephrine infusion and supportive care. N-acetylcysteine was administered to reduce oxidative stress. This case illustrates the clinical features of rare PH3 inhalation poisoning in Korea and highlights the importance of on-site gas detection by firefighters. Rapid field identification may help distinguish PH3 exposure from poisoning by other toxic gases, such as cyanide, and support timely diagnosis and treatment.