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Toxicity, Hydrogen Sulfide: Follow-up

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
Contributor Information and Disclosures

Updated: Mar 24, 2009

Follow-up

Further Inpatient Care

  • Admit the patient to the ICU for any significant exposure (ie, other than chronic low-level exposure with mucous membrane irritation).
  • Consider hyperbaric oxygen for patients who are unresponsive to intravenous nitrites or who have delayed neurologic sequelae.
  • Perform a secondary survey to rule out traumatic injuries (7% of victims).
  • If possible, consult with or admit the patient to a medical toxicologist.

Transfer

  • Transfer the patient if hyperbaric treatment is required but unavailable at the present facility.

Complications

  • Acute respiratory distress syndrome
  • Acute myocardial infarction
  • Delayed neuropsychiatric sequelae

Prognosis

  • Occurrence of long-term neurologic sequelae from hydrogen sulfide exposure is unknown but appears to be linked to longer sublethal exposures.
  • Paradoxically, high-concentration exposures of hydrogen sulfide may have no long-term effects.

Miscellaneous

Medicolegal Pitfalls

  • Failure to establish the correct diagnosis and provide 100% oxygen
  • Failure to protect oneself while entering exposed area during the rescue effort (SCBA protective equipment)
  • Failure to provide trauma assessment and immobilization of unresponsive victims
  • Failure to correct acidosis and hypovolemia
  • Failure to institute antidote therapy in severely ill patients and to transport them to the HBO treatment
 


More on Toxicity, Hydrogen Sulfide

Overview: Toxicity, Hydrogen Sulfide
Differential Diagnoses & Workup: Toxicity, Hydrogen Sulfide
Treatment & Medication: Toxicity, Hydrogen Sulfide
Follow-up: Toxicity, Hydrogen Sulfide
References
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References

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  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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Further Reading

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Keywords

hydrogen sulfide toxicity, hydrogen sulfide exposure, hydrogen sulfide poisoning, rotten egg odor, H2 S toxicity, H2 S poisoning, H2 S, inhalation of hydrogen sulfide

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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.

Medical Editor

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.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & 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.

Managing Editor

John G Benitez, MD, MPH, FACMT, FACPM, FAAEM, Associate Professor, Department of Medicine, Clinical Pharmacology Division, Vanderbilt University; Managing Director, Tennessee Poison Center
John G Benitez, MD, MPH, FACMT, FACPM, FAAEM is a member of the following medical societies: 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.

CME Editor

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, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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