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Hydrogen Sulfide Toxicity Medication

  • Author: Chip Gresham, MD, FACEM; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Jan 27, 2014
 

Medication Summary

Antidotal treatment of hydrogen sulfide (H2 S) poisoning is based on the creation of methemoglobinemia. Symptomatic treatment includes the use of bronchodilators for patients with bronchospasm.

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Cyanide Antidotes

Class Summary

Nitrite administration leads to formation of methemoglobinemia. H2 S has a much greater affinity for methemoglobin than for cellular cytochromes, leading to lower metabolic toxicity.

Sodium thiosulfate & sodium nitrite (Nithiodote)

 

Although approved for use in cyanide poisoning, sodium nitrite is the initial drug of choice for hydrogen sulfide poisoning. Because high methemoglobin concentrations can cause fatal reduction of oxygenation and perfusion, methemoglobin concentrations should be closely monitored and kept below 30%.

Sodium thiosulfate should not be used in the treatment of hydrogen sulfide poisoning. In the classic cyanide antidote kit, sodium nitrite and sodium thiosulfate are provided. The nitrites cause the formation of methemoglobinemia, scavenging both cyanide and hydrogen sulfide. In cyanide poisoning, sodium thiosulfate enhances the activity of the enzyme rhodanese, a mammalian enzyme that likely evolved in response to the ubiquitous presence of cyanide in nature. Rhodanese catalyzes the transfer of sulfate from sodium thiosulfate to cyanide to form thiocyanate, a less toxic form that is excreted by the kidneys. This does not share the crossover treatment that sodium nitrites do with hydrogen sulfide (ie, it is useless in hydrogen sulfide poisoning).

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Contributor Information and Disclosures
Author

Chip Gresham, MD, FACEM Emergency Medicine Physician and Medical Toxicologist, Department of Emergency Medicine, Clinical Director of Medication Safety, Middlemore Hospital; Senior Lecturer, Auckland University Medical School, New Zealand

Chip Gresham, MD, FACEM is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Emma A Lawrey, MBChB, Dip Paeds, PG Cert ClinEd, FACEM Emergency Medicine Consultant and Clinical Toxicology Fellow, Department of Emergency Medicine, Middlemore Hospital, New Zealand

Emma A Lawrey, MBChB, Dip Paeds, PG Cert ClinEd, FACEM is a member of the following medical societies: Australasian College for 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.

Acknowledgements

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 Occupational and Environmental Medicine, American College of Preventive Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

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.

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.

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.

References
  1. Reedy SJ, Schwartz MD, Morgan BW. Suicide fads: frequency and characteristics of hydrogen sulfide suicides in the United States. West J Emerg Med. 2011 Jul. 12(3):300-4. [Medline]. [Full Text].

  2. 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.

  3. 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].

  4. Undefined. [Medline].

  5. 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].

 
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