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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].

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]
  • May cause digestive upset and loss of appetite. 100 Coughing, eye irritation, loss of smell after 2-15 minutes (olfactory fatigue). Altered breathing, drowsiness after 15-30 minutes. Throat irritation after 1 hour.[osha.gov]
  • 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]
  • 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]
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]
  • Symptom Symptoms of hydrogen sulfide poisoning symptoms common symptoms of dry throat dry itching nausea throat dry and burning sensual dizziness faint nose nose chest tightness itchy conjunctival hyperemia Acute hydrogen sulfide poisoning generally rapid[healthfrom.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]
  • 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]
  • 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]
  • 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]
  • 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]
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]
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
  • […] 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]
  • 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]
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]
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]
  • Complication Complications of hydrogen sulfide poisoning Complications Headache Ataxia Consciousness Disorder Delirium Coma Pulmonary edema Pneumonia Acute Respiratory Distress Syndrome Angina Pectoris 1.[healthfrom.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]
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]
  • Moderate poisoning Exposure to high concentrations of hydrogen sulfide after the performance of encephalopathy significantly, there headache, dizziness, irritability, gait staggering, irritability, confusion, delirium, epilepsy-like convulsions can be[healthfrom.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]
  • 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
  • Exposure to high concentrations of hydrogen sulfide after the performance of encephalopathy significantly, there headache, dizziness, irritability, gait staggering, irritability, confusion, delirium, epilepsy-like convulsions can be systemic tonic clonic seizures[healthfrom.com]
  • At high concentrations, only a few breaths are needed to induce unconsciousness, coma, respiratory paralysis, seizures, even death.[blacklinesafety.com]
Disturbance of Consciousness
  • Here, we report the successful revival of a patient suffering from a severe disturbance of consciousness and respiratory failure caused by hydrogen sulfide poisoning; further, his condition was complicated by myocardial infarction.[ncbi.nlm.nih.gov]
  • Central nervous system damage is the most common: (1) exposure to higher concentrations of hydrogen sulfide can be a headache, dizziness, fatigue, ataxia, can occur mild disturbance of consciousness, often first appeared in the eyes and upper respiratory[healthfrom.com]
Bradykinesia
  • On hospital day 7, his mental state became clear, and neurologic examination showed quadriparesis, profound spasticity, increased tendon reflexes, abnormal Babinski response, and bradykinesia.[jstage.jst.go.jp]

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]
  • Adjuncts used in the treatment of cyanide poisoning have been advocated because of the shared mechanism of toxicity between hydrogen sulfide and cyanide.[ncbi.nlm.nih.gov]
  • Provides comprehensive coverage of neurotoxins, especially in the workplace Details the latest science as the foundation for neurotoxicity diagnosis and treatment Presents coverage of the diagnosis and treatment essential for clinical neurologists and[books.google.de]
  • Summary of treatment of hydrogen sulfide poisoning Departments: Other departments of the emergency department Treatment: drug treatment supportive treatment Treatment cycle: 1-3 months Cure rate: 60-70% Commonly used drugs: bumetanil tablets eleven flavored[healthfrom.com]
  • He developed respiratory failure, acute myocardial infarction, ventricular arrhythmia and left ventricular function impairment, requiring artificial ventilation with highly concentrated oxygen, hyperbaric oxygen treatment and drug therapy.[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]
  • 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

  • Introduction Etiology Prevention Complication Symptom Examine Diagnosis Treatment Basic Nursing Introduction Brief introduction of hydrogen sulfide poisoning Hydrogen sulfide (hydrogen sulfide) is a stimulating and asphyxiating colorless gas, low concentrations[healthfrom.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]
Sex distribution
Age distribution

Prevention

  • The preventive measures that should be adopted to avoid this type of poisoning are stressed.[ncbi.nlm.nih.gov]
  • DISCUSSION: Hydrogen sulfide is a mitochondrial toxin and inhibits cytochrome-aa(3) and prevents cellular aerobic metabolism.[ncbi.nlm.nih.gov]
  • Prevention Prevention of Hydrogen Sulfide Poisoning Hydrogen sulfide is a colorless, rotten egg smell of gas, highly toxic, is an air pollutant.[healthfrom.com]
  • 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]
  • How did the exposure occur, and what could’ve been done to prevent it? Like this post? Subscribe to our blog to get content delivered to your inbox.[vividlearningsystems.com]

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: 2018-06-21 21:07