Hydrogen Sulfide Toxicity Clinical Presentation
- Author: Chip Gresham, MD, FACEM; Chief Editor: Asim Tarabar, MD more...
The presence of hydrogen sulfide usually is apparent because of the characteristic rotten egg smell. However, concentrations above 150 ppm may overwhelm the olfactory nerve so that the victim may have no warning of exposure. Similarly, continuous exposure to low concentrations of hydrogen sulfide result in olfactory fatigue/paralysis and loss of the ability to smell or detect the gas even if it is still present in the environment.
Exposures can be subdivided into low-, high-, and very high-level categories. Low-level exposure often is more chronic in nature and usually is seen in industrial settings. Chronic low-level exposure of hydrogen sulfide results primarily in irritation to mucous membranes and the respiratory system. Other toxic effects are headaches, asthenia, and bronchitis.
High-level exposures of hydrogen sulfide result in more neurologic and pulmonary symptoms, as follows:
- Nausea and vomiting
- Possible loss of consciousness
Very high concentrations lead to the following manifestations:
- Myocardial infarction
- Sudden loss of consciousness ("knockdown")
- Cardiopulmonary arrest
Low-level exposure of hydrogen sulfide most often affects the mucous membranes and may show the following few physical signs:
- Conjunctivitis (even at levels of only 4 ppm)
- Green-gray line on gingiva
High-level exposure of hydrogen sulfide may manifest as follows:
- Acute lung injury (patients may present with acute respiratory distress syndrome [ARDS])
Perform a secondary survey to rule out traumatic injuries. Historically, these have been found in about 10% of victims.
Goode E. Chemical Suicides, Popular in Japan, Are Increasing in the U.S. NY Times, June 18, 2011. Available at http://www.nytimes.com/2011/06/19/us/19chemical.html?pagewanted=all.
Fuller DC, Suruda AJ. Occupationally related hydrogen sulfide deaths in the United States from 1984 to 1994. J Occup Environ Med. 2000 Sep. 42(9):939-42. [Medline].
Sams RN, Carver HW 2nd, Catanese C, Gilson T. Suicide with hydrogen sulfide. Am J Forensic Med Pathol. 2013 Jun. 34(2):81-2. [Medline].