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Hydrogen Sulfide Poisoning

Hydrogen Sulphide Toxicity

Although hydrogen sulfide possesses important roles in certain physiological functions of the human body, hydrogen sulfide poisoning is regarded as one of the most common intoxications by a gas in the occupational settings. This compound causes acute toxicity of the lungs and central nervous system, producing manifestations such as a headache, dizziness, changes in consciousness, and respiratory depression with hypoxemia. History taking is crucial for determining exposure to this gas, whereas a confirmation of elevated hydrogen sulfide concentrations is achieved through specialized biochemical tests.


Presentation

Signs and symptoms of hydrogen sulfide poisoning stem from the contact with very high concentrations of this colorless gas (mainly through inhalation) which causes disruption of adenosine triphosphate (ATP) production in the mitochondria [1] [2] [3] [4]. Most cases of poisoning occur in the occupational settings and after carbon monoxide (CO), hydrogen sulfide (H2S) is the second most common cause of work-related death due to gas poisoning [4]. Individuals involved in agriculture, sewage processing, or those who are in regular contact with petroleum have shown to be exposed to significant concentrations of this gas [1] [4]. On the other hand, active volcanoes are a natural source of H2S, meaning that people living in the proximity of volcanoes may also be at risk [4]. Moreover, suicides or intentional poisoning (hydrogen sulfide is listed as a chemical weapon) have also been reported [1] [3]. Hydrogen sulfide poisoning manifests acutely in most cases. The central nervous system (CNS) and the respiratory system (lungs) are the two main organ systems where hydrogen sulfide exerts its toxic effects [4] [5]. Headaches, nausea, vomiting, changes in coordination, and even loss of consciousness are frequent manifestations, while pulmonary edema with subsequent hypoxemia and respiratory depression are main findings involving the respiratory system [4] [6]. Because H2S is able to block calcium channels in the heart, cardiac function can be impaired and lead to ventricular fibrillation or even death from cardiogenic shock in some patients [7] [8] [9].

Hypoxemia
  • This compound causes acute toxicity of the lungs and central nervous system, producing manifestations such as a headache, dizziness, changes in consciousness, and respiratory depression with hypoxemia.[symptoma.com]
  • He was exposed to hydrogen sulfide and presented with Glasgow Coma Score of 5, severe hypoxemia on arterial blood gas analysis, normal chest radiography, and normal blood pressure.[jstage.jst.go.jp]
  • Course (28 y/o male)  An out-of-hospital cardiac arrest victim  Blood tests revealed hypoxemia, hypercapnia, acute renal failure, lactate acidosis and hyperkalemia  Electrocardiogram showed asystole  CPCR failure 7.  Vital signs: T: 33.0 P: 131 bpm[slideshare.net]
Intravenous Administration
  • The therapeutic induction of methemoglobinemia, as by the intravenous administration of sodium nitrite, has both protective and antidotal effects against sulfide as well as against cyanide in laboratory animals.[ncbi.nlm.nih.gov]
Cough
  • At low to moderate levels, signs and symptoms of hydrogen sulfide poisoning may include: irritation of the eyes, nose, and throat headache dizziness nausea vomiting coughing difficulty breathing Exposure to higher levels of hydrogen sulfide may lead to[schmidtandclark.com]
  • Chronic, repeated, lower-level hydrogen sulfide exposure is associated with hypotension, headache, nausea, loss of appetite, weight loss, ataxia, conjunctivitis, chronic cough, and neuropsychological disorders.[merckvetmanual.com]
  • There may also be a loss of appetite along with an upset stomach. 100 ppm After two to 15 minutes of exposure, eye irritation, coughing and a complete loss of smell will occur.[gdscorp.com]
  • Inflammation within the throat area causing coughing, sneezing, excess mucus production, hoarseness, lethargy Dyspnoea Having difficulty breathing Cardiovascular Effects: Chest pain Pain and discomfort within the chest area Cardiac Arrhythmia Having[firstaidcalgary.ca]
  • Symptoms of H 2 S Exposure Low Concentrations Exposure to low concentrations of Hydrogen Sulfide may result in: Sore throat Cough shortness of breath Irritation of the eye, nose & throat High Concentrations Brief Exposure to High concentrations of Hydrogen[duramproducts.com]
Pleural Effusion
Nausea
  • Headaches, nausea, vomiting, changes in coordination, and even loss of consciousness are frequent manifestations, while pulmonary edema with subsequent hypoxemia and respiratory depression are main findings involving the respiratory system.[symptoma.com]
  • At low to moderate levels, signs and symptoms of hydrogen sulfide poisoning may include: irritation of the eyes, nose, and throat headache dizziness nausea vomiting coughing difficulty breathing Exposure to higher levels of hydrogen sulfide may lead to[schmidtandclark.com]
  • […] oxidase a3. like Cyanogen compounds : block cellular respiration, and interferes with oxygen utilization at the cellular level. rapid “Knock down” : inhibiting neuronal cytochrome C oxidase and carbonic anhydrase in CNS. mild dizziness, headaches or nausea[slideshare.net]
  • Nausea and vomiting are also common. Chronic, repeated, lower-level hydrogen sulfide exposure is associated with hypotension, headache, nausea, loss of appetite, weight loss, ataxia, conjunctivitis, chronic cough, and neuropsychological disorders.[merckvetmanual.com]
  • Symptoms may include: Nausea An uncomfortable feeling in the stomach that can cause vomiting Headaches Pain and discomfort within the back of the head, upper neck, front of the head, or sides of the head Delirium State of confusion and the inability to[firstaidcalgary.ca]
Vomiting
  • Headaches, nausea, vomiting, changes in coordination, and even loss of consciousness are frequent manifestations, while pulmonary edema with subsequent hypoxemia and respiratory depression are main findings involving the respiratory system.[symptoma.com]
  • At low to moderate levels, signs and symptoms of hydrogen sulfide poisoning may include: irritation of the eyes, nose, and throat headache dizziness nausea vomiting coughing difficulty breathing Exposure to higher levels of hydrogen sulfide may lead to[schmidtandclark.com]
  • Sources told the TV station at the time investigators suspected carbon monoxide as their cause of death after finding vomit in the car and rash-like splotches on the bodies.[nydailynews.com]
  • Moderate concentrations cause more severe eye and respiratory effects, headache, dizziness, nausea, vomiting, coughing and difficulty breathing. High concentrations can lead to shock, convulsions and inability to breathe.[safetyandhealthmagazine.com]
  • Nausea and vomiting are also common. Chronic, repeated, lower-level hydrogen sulfide exposure is associated with hypotension, headache, nausea, loss of appetite, weight loss, ataxia, conjunctivitis, chronic cough, and neuropsychological disorders.[merckvetmanual.com]
Cyanosis
  • On the other hand, some victims of hydrogen sulfide poisoning exhibit frank cyanosis, suggesting that the respiratory tract obstruction is more common in this condition than is generally recognized.[ncbi.nlm.nih.gov]
  • Cyanosis may be present. Hydrogen sulfide inhalation is associated with cardiac arrhythmias. Nausea and vomiting are also common.[merckvetmanual.com]
  • Signs and Symptoms of Acute Hydrogen Sulfide Exposure: Signs and symptoms of acute exposure to hydrogen sulfide may include tachycardia (rapid heart rate) or bradycardia (slow heart rate), hypotension (low blood pressure), cyanosis (blue tint to skin[cameochemicals.noaa.gov]
Hypotension
  • Symptoms 0.05 ppm (airbone concentration) Pungent smell mimicking “rotten egg” 0.1 ppm Anosmia 50-150 ppm Paralysis, conjunctivitis 250 ppm Photophobia, pulmonary edema 250-500 ppm Headache, nausea, vomiting, confusion, tachycardia, hypotension 500-750[slideshare.net]
  • Chronic, repeated, lower-level hydrogen sulfide exposure is associated with hypotension, headache, nausea, loss of appetite, weight loss, ataxia, conjunctivitis, chronic cough, and neuropsychological disorders.[merckvetmanual.com]
  • Impairment in the metabolic system can cause: Increased blood lactate concentration Is an indicator of having the body going through shock Associated with tachycardia, hypotension, cold and clammy skin Decrease in oxygen uptake Can lead to hypoxia Hydrogen[firstaidcalgary.ca]
  • Signs and Symptoms of Acute Hydrogen Sulfide Exposure: Signs and symptoms of acute exposure to hydrogen sulfide may include tachycardia (rapid heart rate) or bradycardia (slow heart rate), hypotension (low blood pressure), cyanosis (blue tint to skin[cameochemicals.noaa.gov]
Tachycardia
  • Impairment in the metabolic system can cause: Increased blood lactate concentration Is an indicator of having the body going through shock Associated with tachycardia, hypotension, cold and clammy skin Decrease in oxygen uptake Can lead to hypoxia Hydrogen[firstaidcalgary.ca]
  • Symptoms 0.05 ppm (airbone concentration) Pungent smell mimicking “rotten egg” 0.1 ppm Anosmia 50-150 ppm Paralysis, conjunctivitis 250 ppm Photophobia, pulmonary edema 250-500 ppm Headache, nausea, vomiting, confusion, tachycardia, hypotension 500-750[slideshare.net]
  • Signs and Symptoms of Acute Hydrogen Sulfide Exposure: Signs and symptoms of acute exposure to hydrogen sulfide may include tachycardia (rapid heart rate) or bradycardia (slow heart rate), hypotension (low blood pressure), cyanosis (blue tint to skin[cameochemicals.noaa.gov]
Chest Pain
  • pain or tightness Stomach pain, vomiting Headache Increased redness, pain or pus from the area of a skin burn It is important to remain vigilant and avoid complacency with your safety program.[blacklinesafety.com]
  • […] relation to the lungs) edema is not related to heart failure Sore throat/ cough Inflammation within the throat area causing coughing, sneezing, excess mucus production, hoarseness, lethargy Dyspnoea Having difficulty breathing Cardiovascular Effects: Chest[firstaidcalgary.ca]
  • During these episodes there were frequent health complaints including eye, throat and lung irritation, nausea, headache, nasal blockage, sleeping difficulties, weight loss, chest pain, and asthma attacks.[health.ny.gov]
Lacrimation
  • […] source; can cause headaches, nausea and other symptoms Keratoconjunctivitis Inflammation of the cornea and conjunctiva Blepharospasm Muscle spasms that control the eyelid which causes uncontrollable blinking or complete inability to open the eye lids Lacrimation[firstaidcalgary.ca]
  • Exposure to hydrogen sulfide gas may result in skin irritation, lacrimation (tearing), inability to detect odors, photophobia (heightened sensitivity to light), and blurred vision.[cameochemicals.noaa.gov]
Blurred Vision
  • vision, dizziness, nausea Neurological Effects: Neurological effects may be acute or chronic, having the potential to be permanent depending on the severity of exposure.[firstaidcalgary.ca]
  • Exposure to hydrogen sulfide gas may result in skin irritation, lacrimation (tearing), inability to detect odors, photophobia (heightened sensitivity to light), and blurred vision.[cameochemicals.noaa.gov]
Suggestibility
  • No evidence exists to suggest that sulfide poisoning results in an impairment of the oxygen transport capability of blood.[ncbi.nlm.nih.gov]
Headache
  • This compound causes acute toxicity of the lungs and central nervous system, producing manifestations such as a headache, dizziness, changes in consciousness, and respiratory depression with hypoxemia.[symptoma.com]
  • Most recover from memory loss and headache after three hyperbaric oxygen treatments in twenty-four hours from the time of exposure. The case study presented will be of our first patient treated for H2S poisoning.[archive.rubicon-foundation.org]
  • At low to moderate levels, signs and symptoms of hydrogen sulfide poisoning may include: irritation of the eyes, nose, and throat headache dizziness nausea vomiting coughing difficulty breathing Exposure to higher levels of hydrogen sulfide may lead to[schmidtandclark.com]
  • […] of cytochrome oxidase a3. like Cyanogen compounds : block cellular respiration, and interferes with oxygen utilization at the cellular level. rapid “Knock down” : inhibiting neuronal cytochrome C oxidase and carbonic anhydrase in CNS. mild dizziness, headaches[slideshare.net]
  • Once the exposure threshold reaches 30 ppm, the smell becomes very sweet and sickening. 2 to 5 ppm Prolonged exposure at this level will result in headaches, watery eyes, nausea and sleep problems.[gdscorp.com]
Dizziness
  • This compound causes acute toxicity of the lungs and central nervous system, producing manifestations such as a headache, dizziness, changes in consciousness, and respiratory depression with hypoxemia.[symptoma.com]
  • Author: Gloyna, DF ; Wade, J Abstract: Hydrogen Sulfide (H2S) is a colorless, poisonous gas capable of rapidly causing dizziness, unconsciousness, respiratory paralysis, permanent brain damage and death.[archive.rubicon-foundation.org]
  • At low to moderate levels, signs and symptoms of hydrogen sulfide poisoning may include: irritation of the eyes, nose, and throat headache dizziness nausea vomiting coughing difficulty breathing Exposure to higher levels of hydrogen sulfide may lead to[schmidtandclark.com]
  • Other low-level symptoms include nervousness, dizziness, nausea, headache and drowsiness.[nachi.org]
  • Long-term, low level exposure to hydrogen sulfide may result in fatigue, loss of appetite, headaches, irritability, poor memory, and dizziness. More Information Hydrogen Sulfide ToxFAQs, ATSDR Hydrogen Sulfide, OSHA Fact Sheet (PDF)[doh.wa.gov]
Seizure
  • At high concentrations, only a few breaths are needed to induce unconsciousness, coma, respiratory paralysis, seizures, even death.[blacklinesafety.com]

Workup

A detailed patient history is the essential part of the diagnostic workup in patients with hydrogen sulfide poisoning. The physician needs to cover the course of symptoms, their progression, and determine if they may have occurred as a result of exposure at the workplace. If there is suspicion of intentional poisoning, a heterogeneous anamnesis from parents, close relatives, partners, or friends might be useful. A physical examination can further reveal neurological impairment, cardiac disturbances, and respiratory difficulties.

Spirometry, electrocardiography, as well as measurements of blood pressure and echocardiography, are important features of hydrogen sulfide poisoning workup, but significant changes may not always be present [8] [10] [11]. In order to make a definite diagnosis, specific biochemical tests need to be employed. Gas chromatography-mass spectrometry (GC-MS), a tool that is able to detect the concentration of many substances including gases, is the promising method for the diagnosis of hydrogen sulfide poisoning [3] [5]. Blood and urine are used as samples for a measurement of hydrogen sulfide metabolites [3].

Pleural Effusion

Treatment

  • Further evaluation of hyperbaric oxygen therapy as adjunctive treatment of hydrogen sulfide poisoning is recommended.[ncbi.nlm.nih.gov]

Prognosis

  • Moreover, it was found that patients with suicidal attempt had poorer prognosis and needed to more aggressive treatments compared to patients with secondary exposure.[apjmt.mums.ac.ir]
  • Major outcomes occurred in eight cases, along with six deaths. [6] Prognosis Low-level exposures to hydrogen sulfide usually produce local eye and mucous membrane irritation, while high-level exposures rapidly produce fatal systemic toxicity. [7] Exposures[emedicine.medscape.com]
  • For a more complete discussion of the diagnosis and prognosis of RADS, the reader is invited to go to: . For a complete list of references, please contact Dr. Thomas Milby Dr. Thomas H.[experts.com]

Etiology

  • Etiology Hydrogen sulfide most often is encountered as a byproduct of the petroleum, viscose rayon, rubber, and mining industries. [1] The petroleum industry is responsible for most cases of hydrogen sulfide toxicity in North America.[emedicine.medscape.com]
  • In the author's experience, the term RADS is often used imprecisely to describe a host of pulmonary problems that bear little or no relationship, either clinically or etiologically, to the syndrome describe by Brooks and his colleagues.[experts.com]

Epidemiology

  • Seite 69 - Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems. ‎[books.google.de]
  • The objective of this study was to describe the epidemiologic profile of an outbreak of H2S suicides in Japan.[apjmt.mums.ac.ir]
  • These are mixed in an enclosed space, such as a closet or an automobile, and despite the fact that suicide victims often place warning signs on closet doors or car windows, rescue workers and others entering the space have been affected. [3] Epidemiology[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Significant hydrogen sulfide poisoning usually occurs by inhalation. Local irritant effects, along with arrest of cellular respiration, may follow.[emedicine.medscape.com]

Prevention

  • The preventive measures that should be adopted to avoid this type of poisoning are stressed.[ncbi.nlm.nih.gov]
  • Management of access to websites describing suicide methods is an immediate necessity together with counseling for suicide prevention. How to cite this article: Iseki K, Ozawa A, Seino K, Goto K, Tase C.[apjmt.mums.ac.ir]
  • A hydrogen sulfide gas detector will save lives and prevent possible long-term health effects from exposure such as motor function problems, memory gaps, chronic headaches and attention-deficit issues.[gdscorp.com]
  • Eyes: Wear appropriate eye protection to prevent eye contact with the liquid that could result in burns or tissue damage from frostbite.[cameochemicals.noaa.gov]

References

Article

  1. Mustafa AK, Gadalla MM, Sen N, et al. H2S Signals Through Protein S-Sulfhydration. Sci Signal. 2009;2(96):ra72.
  2. Szabo C, Ransy C, Módis K, et al. Regulation of mitochondrial bioenergetic function by hydrogen sulfide. Part I. Biochemical and physiological mechanisms. Br J Pharmacol. 2014;171(8):2099-2122.
  3. Maebashi K, Iwadate K, Sakai K, et al. Toxicological analysis of 17 autopsy cases of hydrogen sulfide poisoning resulting from the inhalation of intentionally generated hydrogen sulfide gas. Forensic Sci Int. 2011;207:91–95.
  4. Wang X, Chen M, Chen X, et al. The Effects of Acute Hydrogen Sulfide Poisoning on Cytochrome P450 Isoforms Activity in Rats.Biomed Res Int. 2014:209393.
  5. Ago M, Ago K, Ogata M. Two fatalities by hydrogen sulfide poisoning: variation of pathological and toxicological findings. Legal Medicine. 2008;10(3):148–152.
  6. Deng M, Zhang M, Sun F, et al. A Gas Chromatography-Mass Spectrometry Based Study on Urine Metabolomics in Rats Chronically Poisoned with Hydrogen Sulfide. Biomed Res Int. 2015:295241.
  7. Zhang R, Sun Y, Tsai H, Tang C, Jin H, Du J. Hydrogen sulfide inhibits L-type calcium currents depending upon the protein sulfhydryl state in rat cardiomyocytes. PloS one. 2012;7(5):e37073.
  8. Haouzi P, Chenuel B, Sonobe T. High dose hydroxocobalamin administered after H2S exposure counteracts sulfide poisoning induced cardiac depression in sheep. Clin Toxicol (Phila). 2015;53(1):28-36.
  9. Sonobe T, Haouzi P. Sulfide intoxication induced circulatory failure is mediated by a depression in cardiac contractility. Cardiovasc Toxicol. 2016;16(1):67-78.
  10. Bates MN, Crane J, Balmes JR, Garrett N. Investigation of Hydrogen Sulfide Exposure and Lung Function, Asthma and Chronic Obstructive Pulmonary Disease in a Geothermal Area of New Zealand. Carpenter DO, ed. PloS one. 2015;10(3):e0122062.
  11. Schinasi L, Horton RA, Guidry VT, Wing S, Marshall SW, Morland KB. Air pollution, lung function, and physical symptoms in communities near concentrated Swine feeding operations. Epidemiology. 2011;22: 208–215.

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Last updated: 2019-06-28 10:05