Noxious gas exposure in the outback: Two cases of hydrogen sulfide toxicity

Gunn, Barry; Wong, Ruby M.

doi:10.1046/j.1442-2026.2001.00220.x

Cited by 17 publications

(17 citation statements)

References 7 publications

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“…Anecdotal reports have mentioned the prompt use of hyperbaric oxygen therapy or hydroxocobalamin but these options remain controversial [18,19].…”

Section: Discussionmentioning

confidence: 99%

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Reversal of Heart and Respiratory Failure Following Accidental Exposure to Hydrogen Sulfide: Case Report

Silva¹

2012

J Med Cases

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Risks of exposure to toxic gases are well recognized during work in sewers, the principal hazards resulting from hypoxia due to the accumulation of methane, carbon dioxide, or hydrogen sulfide and explosive risk as a result of flammable gases. Hydrogen sulfide (H 2 S) is a colourless rotten egg odour gas resulting from organic matter decomposition. The severity of H 2 S intoxication depends on the concentration and duration of exposure and the outcome may be fatal. We report the case of a 59-year-old male patient who was acutely exposed to sewers gases following an accidental leak in a swine facility nearly eighteen hours before. He presented to the emergency room with respiratory complaints and chest pain, and rapidly developed a multi-organ dysfunction syndrome with severe cardio-respiratory failure. No methaemoglobinemia was detected and H 2 S was presumed to be the major implicated toxic substance. Treatment strategy relied mostly on supportive measures with a successful outcome. Approach to victims of exposure to sewers gases should recall the strong possibility of poisoning by H 2 S, a life-threatening condition. Since laboratorial dosing of sulfide compounds is not readily available, the initial approach is based on a high clinical suspicion. H 2 S direct toxicity and cellular hypoxic induction may rapidly lead to multi-organic dysfunction and death. Evidence from case reports suggests that early treatment with nitrites, hyperbaric oxygen therapy and hydroxocobalamin may be beneficial. To the present date, supportive treatment remains the mainstay of care.

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“…Anecdotal reports have mentioned the prompt use of hyperbaric oxygen therapy or hydroxocobalamin but these options remain controversial [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…Hyperbaric oxygen therapy may act by a competitive mechanism against H 2 S at the level of cytochrome oxydase [6,20] and may have a role in the prevention of both short and long-term neurological sequelae [19].…”

Section: Discussionmentioning

confidence: 99%

Reversal of Heart and Respiratory Failure Following Accidental Exposure to Hydrogen Sulfide: Case Report

Silva¹

2012

J Med Cases

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“…At levels of 700-1000 ppm, hydrogen sulfide causes coma, convulsions and, potentially, cardiorespiratory arrest. 8,9 Our simu- Sulfhemoglobin n/a n/a n/a lation suggested levels of ~440 ppm, but estimates ranged from 77 to 2200 ppm depending on a number of factors. 5 In addition, actual H 2 S concentrations in the spreader tank could have reached higher levels due to manure agitation by the workers themselves.…”

Section: Discussionmentioning

confidence: 99%

“…9,18 This suggests a role for hyperbaric oxygen therapy in hydrogen sulfide exposures, although it is not clear whether hyperbaric oxygen enhances the dissociation of the hydrogen sulfide-cytochrome aa3 complex. [16][17][18][19] In addition to the potentially beneficial effects described above, hyperbaric oxygen therapy triggers peripheral vasoconstriction, reduces cerebral edema, increases tissue oxygen tension, decreases leukocyte adhesion (thus inhibiting inflammatory responses), enhances nerve cell regeneration, and decreases lipid peroxidation.…”

Section: Treatmentmentioning

confidence: 99%

“…It is metabolized by oxidation, methylation and metalloprotein reactions, and it is rapidly detoxified to sulfate and thiosulfate by an oxyhaemoglobin-catalyzed reaction. 9 Organs with exposed membrane surface and those with high oxygen demands -notably the brain, lungs and heart -are most susceptible to injury. 1 Brain damage from hydrogen sulfide poisoning is secondary to cerebral edema and ischemic injury, mostly to the brain stem, basal ganglia, hippocampus and vestibular apparatus.…”

Section: Pathophysiologymentioning

confidence: 99%

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Hyperbaric oxygen therapy in the management of two cases of hydrogen sulfide toxicity from liquid manure

Belley

Bernard

et al. 2005

CJEM

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Hydrogen sulfide is a potent lethal gas. Supportive care, nitrite therapy and hyperbaric oxygen are the treatment modalities reported in the literature in cases of hydrogen sulfide exposure. We describe an industrial exposure in which 6 workers inhaled high concentrations of hydrogen sulfide when they entered a closed spreader tank partially filled with liquid swine manure. Five of the 6 lost consciousness, and 2 were agitated and poorly responsive on arrival to the emergency department despite having already received high-flow oxygen for nearly 1 hour. These 2 patients received nitrite therapy followed by orotracheal intubation and hyperbaric oxygen. All patients were discharged home without sequelae after short stays in hospital. The emergency management of hydrogen sulfide exposure is briefly reviewed. RÉSUMÉ L'hydrogène sulfuré est un gaz létal puissant. Dans les cas d'exposition à ce gaz, les modalités de traitement relevées dans la littérature sont les soins de soutien, la thérapie à l'oxyde nitrique et l'oxygénothérapie hyperbare. Une exposition industrielle où six travailleurs inhalèrent de fortes concentrations d'hydrogène sulfuré après avoir pénétré dans un réservoir d'épandeur fermé et partiellement rempli de lisier de porc liquide est présentée. Cinq des six travailleurs perdirent conscience et deux étaient agités et présentaient une réactivité médiocre à leur arrivée au départe-ment d'urgence, bien qu'ils aient reçu de l'oxygène à haut débit pendant presque une heure. Ces deux patients furent soumis à une thérapie à l'oxyde nitrique suivie d'une intubation orotrachéale et d'une oxygénothérapie hyperbare. Tous les patients reçurent leur congé sans séquelles après une courte hospitalisation. La prise en charge à l'urgence de l'exposition à l'hydrogène sulfuré est brièvement passée en revue.

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