Inhalation of hydrogen sulphide: a case of subacute manifestations and long term sequelae.

Abstract

mmHg, pH 7-45, So2 96%. The patient remained asymptomatic except for a residual exertion dyspnoea after five months. Blood parameters had returned to normal values but lung volumes and DLCO were still low five months after the admittance. Our diagnosis from this background was pneumonitis produced by inhalation of toxic gas. After the reported accident the toilet facilities were closed and the Generalitat de Catalunya Occupational Health Department carried out an investigation two days later. The autopsy of the dead worker showed haemorrhagic bronchitis and identified asphyxia as the cause ofdeath probably secondary to inhalation of a toxic gas. Concentrations of toxic materials in blood were not measured. Concentrations of toxic gases above the threshold limit values were not found in the toilets two days after the accident. The lavatories were connected, however, without a siphon, to a manure pit. The facts that could explain a leak through this circuit were the lack of syphon and the fact that the toilets and the manure pit where they drained had been out of order for several months, being used again only just before the accident. That would have allowed hydrogen sulphide and other gases from the organic decomposition in the pit to accumulate. Neither the absence of hydrogen sulphide in the toilet air nor the absence of the characteristic smell in most cases rule out the diagnostic hypothesis of hydrogen sulphide toxicity as the investigation was carried out two days after the accident and the toilet had been aired before the samples were taken. Furthermore it is well known Service of Pneumology, Hospital

Is a reduction in residual volume a sub-clinical manifestation of hydrogen sulfide intoxication?

“…However, this ®nding may be signi®cant and supports the observation of Parra et al [1991] which was based on a single case report. It is suggested that an isolated reduction in RV may represent a sub-acute manifestation of H 2 S intoxication.…”

“…Owens et al [1987] in a study of 69 patients noted this ®nding in a group of 11 subjects who had inhaled potentially toxic substances including ammonia, sulfur dioxide, and pesticides. Parra et al [1991] suggested the development of a mild ®brosis, with some decrease in lung volumes and gas transfer, subsequent to H 2 S inhalation while Green et al [1991] have demonstrated that exposure to H 2 S may adversely affect the properties of pulmonary surfactant.…”

Hydrogen sulfide poisoning: Clarification of some controversial issues

“…These sources include toilets [Parra et al, 1991], sewers [Richardson, 1995;Watt et al, 1997], and liquid manure pits [Osbern and Crapo, 1981;Donham et al, 1982]. Some of these reports describe exposure-related pulmonary injuries that investigators attribute to hydrogen sulfide toxicity.…”

Respiratory effects of chronic hydrogen sulfide exposure

“…The usual levels of exposure to H,S in these trades are very low (0.5-10 ppm) [Parmeggiani, 19831. The lack of research on the long-term health effects of low level H,S exposure has been acknowledged by NIOSH [ 19771 as a barrier to establishing well-informed personal exposure limits. Nonetheless, several authors have suggested that low level H,S exposure may lead to decreased lung function [Parra et al, 1991;Zuskin et al, 19931. Hydrogen sulfide dissociates on contact with water to form caustic sulfides; therefore, it can irritate the mucous membrane of the respiratory system.…”