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

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