Hydrogen Sulfide Toxicity Clinical Presentation

  • Author: Sujal Mandavia, MD, FRCP(C), FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 3, 2011
 

History

The presence of H2 S 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. 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. Patients exposed to continuous low-level concentrations or after acute exposure to the very high concentrations of hydrogen sulfide can lose their ability to smell/detect the gas even though it is still present in the environment (olfactory fatigue/paralysis).

  • Headaches
  • Asthenia
  • Bronchitis

High-level exposures of hydrogen sulfide result in more neurologic and pulmonary symptoms.

  • Cough
  • Dyspnea
  • Vertigo
  • Confusion
  • Nausea and vomiting
  • Possible loss of consciousness
  • Hemoptysis

Very high concentrations lead to cardiorespiratory arrest because of brainstem toxicity.

  • Myocardial infarction
  • Sudden loss of consciousness ("knockdown")
  • Seizure
  • Cardiopulmonary arrest
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Physical

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)
  • Pharyngitis
  • Green-gray line on gingiva
  • Wheezing

High-level exposure of hydrogen sulfide may elicit the following signs:

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Causes

  • H2 S most often is encountered as a byproduct of the petroleum, viscose rayon, rubber, and mining industries.
  • Organic decomposition of sulfur compounds in sewers, barns, liquid manure pits, ships' holds, and sulfur springs also produces H2 S.
  • The petroleum industry is responsible for most cases of H2 S toxicity in North America.
  • In nature, hydrogen sulfide can be found in caves, sulfur springs, underground deposits of natural gas, or as result of volcanic eruptions.
  • Hydrogen sulfide has recently been implicated in suicides in Japan.[3]
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Contributor Information and Disclosures
Author

Sujal Mandavia, MD, FRCP(C), FACEP  Clinical Assistant Professor of Emergency Medicine, USC, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles County-University of Southern California Medical Center

Sujal Mandavia, MD, FRCP(C), FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

David C Lee, MD  Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH  Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

  2. Fuller DC, Suruda AJ. Occupationally related hydrogen sulfide deaths in the United States from 1984 to 1994. J Occup Environ Med. Sep 2000;42(9):939-42. [Medline].

  3. Truscott A. Suicide fad threatens neighbours, rescuers. CMAJ. Aug 12 2008;179(4):312-3. [Medline].

  4. Gregorakos L, Dimopoulos G, Liberi S, Antipas G. Hydrogen sulfide poisoning: management and complications. Angiology. Dec 1995;46(12):1123-31. [Medline].

  5. Hall AH, Rumack BH. Hydrogen sulfide poisoning: an antidotal role for sodium nitrite?. Vet Hum Toxicol. Jun 1997;39(3):152-4. [Medline].

  6. Hessel PA, Herbert FA, Melenka LS, et al. Lung health in relation to hydrogen sulfide exposure in oil and gas workers in Alberta, Canada. Am J Ind Med. May 1997;31(5):554-7. [Medline].

  7. Kilburn KH, Warshaw RH. Hydrogen sulfide and reduced-sulfur gases adversely affect neurophysiological functions. Toxicol Ind Health. Mar-Apr 1995;11(2):185-97. [Medline].

  8. Milby TH, Baselt RC. Hydrogen sulfide poisoning: clarification of some controversial issues. Am J Ind Med. Feb 1999;35(2):192-5. [Medline].

  9. Richardson DB. Respiratory effects of chronic hydrogen sulfide exposure. Am J Ind Med. Jul 1995;28(1):99-108. [Medline].

  10. Smilkstein MJ, Bronstein AC, Pickett HM, Rumack BH. Hyperbaric oxygen therapy for severe hydrogen sulfide poisoning. J Emerg Med. 1985;3(1):27-30. [Medline].

  11. Snyder JW, Safir EF, Summerville GP, Middleberg RA. Occupational fatality and persistent neurological sequelae after mass exposure to hydrogen sulfide. Am J Emerg Med. Mar 1995;13(2):199-203. [Medline].

  12. Watt MM, Watt SJ, Seaton A. Episode of toxic gas exposure in sewer workers. Occup Environ Med. Apr 1997;54(4):277-80. [Medline].

  13. Whitcraft DD, Bailey TD, Hart GB. Hydrogen sulfide poisoning treated with hyperbaric oxygen. J Emerg Med. 1985;3(1):23-5. [Medline].

 
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