Hydrogen Sulfide Gas
Exposure
- Breakdown of Organic Materials
- Sewer Gas
- Sulfur Spring
- Fishing Hold
- Mining Exposure
- Industrial Byproduct
- Petroleum Extraction and Refining
- Leather Tanning
- Rubber Vulcanization
- Heavy Water Production
- Synthetic Fabric Manufacture
- Metal Refining
- Glue and Felt Manufacturing
Physiology
- Hydrogen Sulfide Gas Inhalation
- Characteristics of Hydrogen Sulfide Gas: “rotten-egg” odor, colorless gas
- Absorption of Hydrogen Sulfide Gas: absorbed through tracheobronchial mucosa
- Effects of Hydrogen Sulfide
- Respiratory Irritant
- Cytotoxic Asphyxiant: results in impairment of cytochrome oxidase and cellular respiration
- Metabolism of Hydrogen Sulfide: detoxified to sulfate metabolites, which are excreted renally
Clinical
Upper Respiratory Tract Manifestations
- Rhinitis: more prominent in lower-intensity exposures
- Conjunctivitis: more prominent in lower-intensity exposures
Pulmonary Manifestations
- Cough (see Cough): more prominent in lower-intensity exposures
- Hypoxemia/Hypercapnia
- Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS)
- Pathology: diffuse alveolar damage
Neurologic Manifestations
Cardiovascular Manifestations
- Hypotension/Rapid Cardiovascular Collapse (see Hypotension)
- Clinical: may occur with high-intensity exposure
Renal Manifestations
Treatment
- Remove from Exposure: provide 100% oxygen
- Steroids: may be benficial in acute lung injury, but unproven
- Nitrites (use as in cyanide intoxication, but without thiosulfate): binds sulfide ion, removing it from cytochrome oxidase
- May be useful in cardiac arrest situation, but use is undefined
- Use immediately upon presentation (since sulfide bound to cytochrome is oxidized rapidly)
- Hyperbaric Oxygen: may be used in refractory cases
Prognosis
- Death: may occur with high-intensity exposure
References
