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Hydrogen Sulfide Poisoning
Aka: Hydrogen Sulfide Poisoning, Hydrogen Sulfide Toxicity, Hydrogen Sulfide, Hydrogen Sulfide Gas
- Background: Hydrogen Sulfide
- Hydrogen Sulfide is a Sulfur-Based Toxic Gas
- Flammable, colorless gas
- Poisonous
- Malodorous (rotten egg smell)
- Air Pollutant
- Manufacturing reagent
- Chemical manufacturing
- Petroleum processing
- Sewage processing
- Metallurgy
- Agriculture
- Analytical Chemistry
- Pathophysiology: Hydrogen Sulfide Toxicity
- Toxicity
- Cytochrome C Oxidase inhibition
- Neuronal Potassium channels hyperpolarized
- Oxygen radicals form
- Corrosive at mucous membranes
- Concentrations >100 ppm result in Loss of Smell by olfactory paralysis (no rotten egg smell detected)
- Concentrations >500 ppm are rapidly lethal by inhalation
- History
- Sudden collapse in an enclosed work area (esp. if rotten egg smell was reported)
- Signs
- Ocular
- Conjunctivitis
- Cardiopulmonary
- Dyspnea
- Cyanosis
- Rales
- Acute Respiratory Distress Syndrome (ARDS)
- Gastrointestinal
- Nausea
- Vomiting
- Neurologic
- Headache
- Syncope
- Seizures
- Labs
- See Poisoning
- Sulfide concentrations
- Blood sulfide concentration
- Blood and urine thiosulfate concentration
- Venous Blood Gas (or Arterial Blood Gas)
- Metabolic Acidosis (due to Lactic Acidosis)
- Imaging
- Head MRI or Head CT
- As indicated for neurologic findings
- Management
- Respiratory Management
- Nonrebreather 100% oxygen
- Noninvasive Positive Pressure Ventilation (e.g. BiPap) or Mechanical Ventilation with PEEP
- Hypotension management
- Intravenous Fluids
- Vasopressors
- Sulfide Antidotes
- Sodium Nitrite 3% 0.2 ml per kg (children) up to 10 ml or 300 mg in adults IV over 2-4 min
- Hydroxycobalamin (cyanokit) 2.8 ml/kg or 70 mg/kg (children) up to 200 ml or 5 g in adults over 15 min
- Cobinamide (experimental)
- Disposition
- Admit all patients with respiratory of neurologic signs or symptoms
- Patients with only mild mucosal irritation (e.g. Conjunctivitis) may be discharged home
- Complications
- Neurologic and psychiatric sequelae may be longstanding
- Resources
- Hydrogen Sulfide (OSHA)
- https://www.osha.gov/hydrogen-sulfide
- Hydrogen Sulfide Toxicity (Stat Pearls)
- https://www.ncbi.nlm.nih.gov/books/NBK559264/
- References
- Tomaszewski (2017) Crit Dec Emerg Med 31(10): 24