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Sulfur Dioxide Poisoning
Aka: Sulfur Dioxide Poisoning, Sulfur Dioxide, Sulfurous Anhydride, Sulfurous Oxide
- 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
- 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
- Pharmacokinetics
- Irritation level exposure: 20 ppm
- Life threatening level exposure: 100 ppm
- Findings: Initial Irritant-Level Exposure
- Mucosal Irritation
- Irritant Conjunctivitis
- Nasal irritation
- Pharyngitis
- Respiratory Irritation
- Cough
- Wheezing
- Chest Tightness
- Skin Irritation
- Skin redness and pain
- Blisters may occur
- Findings: Significant Inhalation Injury
- Bronchospasm or reactive airway findings
- Obstructive Lung Disease exacerbation (Asthma Exacerbation, COPD exacerbation)
- Acute Respiratory Distress Syndrome
- Imaging
- Chest XRay
- Indicated for presentation with ongoing respiratory symptoms
- Diagnostics
- Obtain Pulse Oximetry
- 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
- Complications
- Chronic Bronchitis
- Pulmonary Fibrosis
- Bronchiolitis Obliterans
- Resources
- Sulfur Dioxide Exposure Medical Management (CDC)
- https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=249&toxid=46
- Sulfur Dioxide Safety Data Sheet (Canadian Occupational Safety)
- https://www.ccohs.ca/oshanswers/chemicals/chem_profiles/sulfurdi.html
- Sulfur Dioxide Poisoning (Kansas Poison Control)
- https://www.kansashealthsystem.com/-/media/Files/PDF/More-Poisons/Sulfur-Dioxide.pdf
- References
- Tomaszewski (2018) Crit Dec Emerg Med 32(6):32