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Hydrogen Sulfide (H 2 S). Hydrogen Sulfide - Overview. Colorless, irritating, flammable gas, heavier than air Rotten egg odor (concentrations > 0.5 ppm) Soluble in water, forming sulfuric acid. Hydrogen Sulfide - Overview. Commercial and industrial use Petroleum Viscose rayon Rubber

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hydrogen sulfide overview
Hydrogen Sulfide - Overview
  • Colorless, irritating, flammable gas, heavier than air
  • Rotten egg odor (concentrations > 0.5 ppm)
  • Soluble in water, forming sulfuric acid
hydrogen sulfide overview3
Hydrogen Sulfide - Overview
  • Commercial and industrial use
    • Petroleum
    • Viscose rayon
    • Rubber
    • Food processing
    • Tanning
    • Mining industries
hydrogen sulfide toxicity
Hydrogen Sulfide - Toxicity
  • Major route by inhalation
  • Lower doses
    • Eye and upper respiratory tract
  • Higher doses
    • Cellular respiration may cease
    • Affects all organs
    • Nervous system
  • GI absorption rarely occurs
hydrogen sulfide toxicity5
Hydrogen Sulfide - Toxicity
  • Children more vulnerable than adults
  • Most acute poisonings from accidental gas formation
  • OSHA standard: 20 ppm (max: 50 ppm for up to 10 minutes)
  • NIOSH standard: 10 ppm
  • Sudden death can occur at levels >700 ppm
protective equipment
Protective Equipment
  • Easily detected and avoided by odor
  • Chemical-protective clothing advised
  • Breathing protection required
    • Positive-pressure, self-contained breathing apparatus (SCBA)
    • Supplied-air respirator with a full facepiece
detection
Detection
  • Portable and fixed gas monitors available commercially
    • Sensors operate in the range from 0 – 500 ppm
decontamination
Decontamination
  • Relocate exposed victims to fresh air immediately
  • Remove residue with soap and water
  • Dilute sulfuric acid with large amounts of water
signs and symptoms
Signs and Symptoms
  • Low-level exposures common in industrial settings
  • Low-level exposures produce
    • Local eye and mucous membrane irritation
    • Mild systemic effects
    • Chemical bronchitis with repeated exposure
  • On exam
    • Evidence of conjunctivitis and wheezing
    • Gray-green line on the gingiva from long-term exposures
signs and symptoms10
Signs and Symptoms
  • Eye irritation develops at levels as low as 4 ppm
  • Pulmonary membrane irritation is evident with exposures > 20 ppm
signs and symptoms11
Signs and Symptoms
  • Higher-level exposures (50-400 ppm)
    • Severe cardiopulmonary and systemic effects
  • Continued exposure results
    • Pulmonary edema
      • Victim may present in fulminate acute respiratory distress syndrome (ARDS)
signs and symptoms12
Signs and Symptoms
  • Severe high-level exposure (>500 ppm)
    • Fatal systemic toxicity
      • Myocardial infarction, seizure, coma, and cardiopulmonary arrest
  • Just 2-3 breaths of HS at >700 ppm
    • Immediate death
  • Environment awareness of exposure site to determine secondary findings
laboratory
Laboratory
  • Diagnostic findings are consistent with other hemoglobinopathies
  • Arterial blood gases
    • Marked uncompensated metabolic acidosis
    • pO2 and calculated oxygen saturation are within reference range
    • Measured oxygen saturation is often low
  • Elevated levels of carboxyhemoglobin or methemoglobin
laboratory14
Laboratory
  • Normal chest x-ray, unless pulmonary edema develops
  • Ischemia, infarction patterns or various arrhythmias may be evident on ECG
  • Chronic low-level exposures
    • CT or MRI scan of the head
      • Basal ganglia lesions
  • Urinary thiosulfate levels confirm exposure
treatment
Treatment
  • Treatment based on creating methemoglobinemia
    • Treat initially with 100% oxygen and amyl nitrite
    • Sodium nitrite
      • Dose of 0.33 cc/kg of 3% solution, via slow IV push, to a maximum of 10 cc
      • Pediatric dosing is the same
      • Contraindication: hypersensitivity to drug
treatment16
Treatment
  • Treatment based on creating methemoglobinemia
    • High methemoglobin levels exacerbate ischemia in those with poor cardiopulmonary reserves
    • Adjust dosage for severe anemia
treatment17
Treatment
  • Control hypoxia with oxygen supplementation
  • To delay and/or minimize pulmonary edema
    • Positive airway pressure intermittent positive pressure breathing (IPPB),
    • Positive end-expiratory pressure (PEEP) mask
    • Intubation
treatment18
Treatment
  • Acute bronchospasm: aerosolized bronchodilators
  • For children with stridor: epinephrine aerosol
  • Hyperbaric oxygen (HBO) therapy is beneficial
  • Steroids advised if given within 15 minutes
long term medical sequelae
Long-Term Medical Sequelae
  • Delayed neuropsychiatric sequelae
    • Vision and memory impairment
    • Rigid movements, reduced motor function, slight tremor, and ataxia
    • Psychosis
    • Abnormal learning and retention
    • Mild cerebral atrophy
  • Not classified for carcinogenicity, mutagenicity or teratogenicity
environmental sequelae
Environmental Sequelae
  • Will form sulfur dioxide and sulfuric acid in the air
  • Sulfur dioxide major component in acid rain
  • Remains in the atmosphere ~ 18 hours
summary
Summary
  • Potential for terrorist use
    • Easily produced
    • Highly toxic
    • Capable of producing panic and disruption
  • Exposure by inhalation
  • Toxic effects include hemoglobinopathy, disrupting cellular respiration
summary22
Summary
  • Low-level exposures
    • Eye and mucous membrane irritation
  • Higher exposures
    • Cardiopulmonary and CNS effects
      • Pulmonary edema, myocardial infarct and death
  • Methemoglobinemia treatment
    • Antidote: Sodium nitrite