II. Background
- Highly toxic, colorless, water-soluble, nonflammable gas
- Pungent odor and highly irritating
- Sulfur Dioxide forms sulfurous acid when combined with water
- Sources
- Environmental air pollutant
- Coal-fired power plants
- Copper Smelters
- Oil Refineries
- Volcanic Eruptions
- Chemical agent in Manufacturing (pharmaceutical aid, antioxidant)
- Sulfuric Acid Manufacturing
- Food Preservation Facilities (e.g. dried fruit preparation)
- Fertilizer manufacture
- Paper Manufacturing
- Disinfectant in breweries, granaries and food factories
- Environmental air pollutant
III. Mechanism
- Upper airway irritation
- Water soluble gas deposits as sulfurous acid on mucosa of upper airway and resulting in irritation
-
Inhalation Injury
- Oxidative injury to lung on deep inspiration
IV. Pharmacokinetics
- Irritation level exposure: 20 ppm
- Life threatening level exposure: 100 ppm
V. Findings: Initial Irritant-Level Exposure
- Mucosal Irritation
- Irritant Conjunctivitis
- Nasal irritation
- Pharyngitis
- Respiratory Irritation
- Skin Irritation
- Skin redness and pain
- Blisters may occur
VI. Findings: Significant Inhalation Injury
- Bronchospasm or reactive airway findings
- Obstructive Lung Disease exacerbation (Asthma Exacerbation, COPD exacerbation)
- Acute Respiratory Distress Syndrome
VII. Imaging
-
Chest XRay
- Indicated for presentation with ongoing respiratory symptoms
VIII. Diagnostics
- Obtain Pulse Oximetry
IX. Management
-
Decontamination of symptomatic patients
- Eye Irrigation
- Wash skin
- No risk of exposures to medical staff (outside original Sulfur Dioxide exposure site)
- Supportive Care
- Supplemental Oxygen for Hypoxia
- Inhaled or Nebulized Albuterol for bronchospasm, Wheezing
- No evidence for Corticosteroids (consider for Obstructive Lung Disease exacerbation)
- No Antibiotic prophylaxis recommended
- Disposition
- May discharge at 4-6 hours after exposure if asymptomatic
- Hospital observation for persistent respiratory symptoms beyond 4-6 hours from exposure
X. Complications
- Chronic Bronchitis
- Pulmonary Fibrosis
- Bronchiolitis Obliterans
XI. Resources
- Sulfur Dioxide Exposure Medical Management (CDC)
- Sulfur Dioxide Safety Data Sheet (Canadian Occupational Safety)
- Sulfur Dioxide Poisoning (Kansas Poison Control)
XII. References
- Tomaszewski (2018) Crit Dec Emerg Med 32(6):32
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Related Studies
| Definition (MSH) | A highly toxic, colorless, nonflammable gas. It is used as a pharmaceutical aid and antioxidant. It is also an environmental air pollutant. |
| Definition (ALT) | Sulphur dioxide. |
| Concepts | Hazardous or Poisonous Substance (T131) , Inorganic Chemical (T197) |
| MSH | D013458 |
| SnomedCT | 86233005 |
| English | Anhydride, Sulfurous, Dioxide, Sulfur, Sulfur Dioxide, Sulfurous Anhydride, SO2, Sulfur Dioxide [Chemical/Ingredient], sulphur dioxide, so2, SULFUR DIOXIDE, sulfur dioxide, Sulfur dioxide, Sulfurous anhydride, Sulphur dioxide, Sulfur dioxide (substance), Sulphurous anhydride, Sulphurosum acidum / sulphur dioxide, sulphurosum acidum/sulphur d |
| Russian | СЕРНИСТЫЙ ГАЗ, SERNISTYI GAZ, SERY DVUOKIS', SERNISTYI ANGIDRID, SERY DIOKSID, СЕРНИСТЫЙ АНГИДРИД, СЕРЫ ДВУОКИСЬ, СЕРЫ ДИОКСИД |
| German | Schwefelhaltiges Anhydrid, Schwefliges Anhydrid, Schwefeldioxid |
| French | Anhydride sulfureux, SO2, Dioxyde de soufre |
| Swedish | Svaveldioxid |
| Czech | oxid siřičitý |
| Finnish | Rikkidioksidi |
| Japanese | 二酸化硫黄 |
| Croatian | SUMPORNI DIOKSID |
| Polish | Bezwodnik siarkawy, Dwutlenek siarki |
| Norwegian | Svoveldioksid |
| Spanish | Dióxido Sulfurado, anhídrido sulfuroso, dióxido de azufre (sustancia), dióxido de azufre, Dióxido de Azufre |
| Italian | Anidride solforosa |
| Portuguese | Dióxido de Enxofre |
Ontology: poisoning by sulfur dioxide (C2082856)
| Concepts | Injury or Poisoning (T037) |
| English | poisoning by sulfur dioxide, poisoning by sulfur dioxide (diagnosis) |
