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Sulfur Dioxide Poisoning

Poisoning by Sulfur Dioxide

Sulfur dioxide, as one of the main air pollutants, is described as an important cause of cardiorespiratory disease and associated mortality. Exposure is primarily seen in the occupational setting. Known for its effects of inducing bronchoconstriction after inhalation, patients principally report symptoms such as dyspnea and cough, whereas rare cases may progress to severe insufficiency. The diagnosis rests on identifying exposure and clinical workup by the physician.


Presentation

Sulfur dioxide (SO2) is one of the more important air pollutants described in the literature, along with nitrogen dioxide (NO2) and carbon monoxide (CO) [1]. Having in mind the fact that SO2 arises from both natural and industrial (fossil fuel combustion, smelting) sources, poisoning from this gas can be seen in both occupational and non-occupational circumstances [2] [3]. Several studies have confirmed its effect on human body, most notably on the respiratory system [1] [2] [4] [5] [6]. Namely, bronchoconstriction, as a result of an inflammatory reaction and irritation of the bronchial mucosa, is one of the principal effects of SO2, which may result in symptoms such as dyspnea, wheezing, and a cough, but also exacerbation of underlying pulmonary disorders, such as asthma [3] [5] [7]. In fact, reports indicate that SO2-polluted air might be one of the causes of increased prevalence of asthma in the pediatric population [8]. Mucosal hypersecretion is also described as an important symptom of sulfur dioxide poisoning [7]. Prolonged exposure to high concentrations of SO2 might lead to more severe forms of respiratory injury, including pulmonary fibrosis and acute respiratory distress syndrome (ARDS) [3]. Cigarette smoking was identified as a risk factor for a more severe respiratory symptomatology [7]. In addition to lung-related symptoms, many studies have established a strong connection between increased mortality rates due to cardiovascular diseases and exposure to SO2 [5] [6] [9]. SO2 is known for its ability to disrupt neuronal signaling responsible for heart rate control and may result in tachycardia, although cessation of exposure to SO2 is sufficient to abolish its effects [4]. Because SO2 is a mucosal irritant, its harmful effect on the conjunctiva, the gastrointestinal tract, and even the skin, is also described.

Respiratory Insufficiency
  • The preponderance of scientific evidence suggests that permanent central nervous system sequelae result from hypoxia secondary to respiratory insufficiency (Beauchamp, et al., 1984; Milby & Baselt, 1999a; Riffenstein, et al., 1992).[experts.com]
Agent Orange
  • Orange Other Military Personal and General Environment 1381 Pentachlorophenol and Tetrachlorophenol 1194 George D Thurston and Lance A Wallace 1400 Trimellitic Anhydride and Other Acid Robert B Devlin and Donald W Graff 1434 Carbon Disulfide 1219 97[books.google.de]

Workup

The diagnosis of sulfur dioxide poisoning might be challenging, especially in the absence of specific tests. For this reason, the physician and its ability to perform a detailed clinical assessment is the essential step in the workup. In the presence of undisclosed respiratory complaints, a complete patient history, including the patient's socioepidemiological data (living in industrial areas, or in proximity to factories or heavily polluted areas). The patient's occupancy (and to which substances is the individual exposed on a daily basis) must be assessed during history taking, as studies point to chronic low-dose SO2 exposure at the workplace as a very important source [3] [7]. Physicians must also identify whether undrelying chronic pulmonary diseases are present and if exacerbation of associated symptoms has occurred. Once the clinical evaluation is completed, pulmonary function testing (in the form of spirometry) and imaging studies (either plain radiography or computed tomography) of the chest should be employed [3], primarily to determine the optimal therapeutic strategy.

Treatment

  • 1- Ore and metal refining 2- Chemical manufacturing 3- Wood pulp treatment 4- Sulfur dioxide content of disinfectant, refrigerant and in dried food preservatives 5- Cement manufacturing workers This gas contributes to respiratory illness, particularly[quizlet.com]
  • Treatment is urgently required. Transport to a hospital. Ingestion: Not applicable (gas). First Aid Comments: Some of the first aid procedures recommended here require advanced first aid training.[ccohs.ca]
  • See also hydrogen sulfide poisoning. sulfur dioxide a poisonous gas liberated by some industrial enterprises, e.g. copper smelting, from silage to which sodium metabisulfite has been added as a preservative and in oldfashioned treatments for mange.[medical-dictionary.thefreedictionary.com]
  • Long-term studies surveying large numbers of children indicate that children who have breathed sulphur dioxide pollution may develop more breathing problems as they get older, may make more emergency room visits for treatment of wheezing fits, and may[health24.com]
  • Also, it is applied in water treatment to reduce residual chlorine. In clay processing it reduces iron compounds and other color-forming impurities.[chemicalbook.com]

Prognosis

  • 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

  • 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

  • It should be noted that there are a number of issues related to interpretation of the epidemiology literature.[canada.ca]
  • Information on the effects of exposure for longer periods (e.g. 24-hour) is obtained from epidemiological studies, which show associations between contaminants such as SO 2 and health impacts in communities and selected panels.[mfe.govt.nz]
  • The study was published online July 18 in the American Journal of Epidemiology. In their study, researchers used statewide birth data from 1998 through 2004.[livescience.com]
Sex distribution
Age distribution

Prevention

  • Prevent sulfur dioxide exposure in paper mills The U.S.[airsystems-inc.com]
  • […] used as an antioxidant in pharmaceutical preparations; it is also an important air pollutant, irritating the eyes and respiratory tract. sul·fur di·ox·ide a colorless, nonflammable gas with a strong, suffocating odor; a powerful reducing agent used to prevent[medical-dictionary.thefreedictionary.com]
  • […] additive to wine to destroy molds, bacterias, and undesired wild yeast; to prevent formation of nitrosamines in beer in the malting process; and in producing highfructose corn syrups.[chemicalbook.com]
  • In addition, it is used in the preparation and preservation of food due to its ability to prevent bacterial growth and browning of fruit.[sciencing.com]
  • Sulfites, such as sulfur dioxide, not only help prevent foods from becoming discolored, they also discourage the growth of bacteria. Additionally, they can soften dough or bleach foods.[livestrong.com]

References

Article

  1. Chen TM, Gokhale J, Shofer S, Kuschner WG. Outdoor air pollution: nitrogen dioxide, sulfur dioxide, and carbon monoxide health effects. Am J Med Sci. 2007;333(4):249-256.
  2. Andersson E, Murgia N, Nilsson T, Karlsson B, Torén K. Incidence of chronic bronchitis in a cohort of pulp mill workers with repeated gassings to sulphur dioxide and other irritant gases. Environ Health. 2013;12:113.
  3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  4. Woerman AL, Mendelowitz D. Postnatal Sulfur Dioxide Exposure Reversibly Alters Parasympathetic Regulation of Heart Rate. Hypertension. 2013;62(2):274-280.
  5. Tunnicliffe WS, Hilton MF, Harrison RM, Ayres JG. The effect of sulphur dioxide exposure on indices of heart rate variability in normal and asthmatic adults. Eur Respir J. 2001;17(4):604-608.
  6. Kan H, Wong C-M, Vichit-Vadakan N, Qian Z, the PAPA Project Teams. Short-term association between sulfur dioxide and daily mortality: the Public Health and Air Pollution in Asia (PAPA) study. Environ Res. 2010;110(3):258-264.
  7. Osterman JW, Greaves IA, Smith TJ, Hammond SK, Robins JM, Thériault G. Respiratory symptoms associated with low level sulphur dioxide exposure in silicon carbide production workers. Br J Ind Med. 1989;46(9):629-635.
  8. Sunyer J, Atkinson R, Ballester F, et al. Respiratory effects of sulphur dioxide: a hierarchical multicity analysis in the APHEA 2 study. Occup Environ Med. 2003;60(8):e2.
  9. Sunyer J, Ballester F, Tertre AL, et al. The association of daily sulfur dioxide air pollution levels with hospital admissions for cardiovascular diseases in Europe (The Aphea-II study). Eur Heart J. 2003;24(8):752-760.

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Last updated: 2018-06-21 22:35