Acute mercury vapor poisoning is an uncommon but potentially fatal toxicologic emergency. A case series is presented of a family who became exposed to mercury vapor as a result of home gold ore processing. The severity of the poisoning necessitated mechanical ventilation in three of the eight patients who were exposed. Despite aggressive management, two patients died, because their clinical course was dominated by irreversible pulmonary toxicity. The remaining survivors developed varying degrees of mercury toxicity. The pathophysiology, clinical presentation and current treatment guidelines for acute mercury vapor poisoning are emphasized.