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Aggressive treatment, outcome and longtime neurologic and pulmonarycomplications of lethal hydrogen sulphide

(H2S) intoxicationMLNG Malbrain, P Bomans, G Rappoort and I Demeyer

Intensive Cure Unit and epartment of !neumology, Algemeen "ie#enhuis

Stulven$erg, %ange &eelde#ensstraat 2', &2*'* Ant+erpen ', &elgium

from th International Symposium on Intensive Care and -mergency

.edicine

&russels, &elgium, /02 .arch 11

Critical Care11, 1(Suppl ):!2 doi3*4/'5cc11

Published .arch 11

6 11 Current Science %td

Introduction

Hydrogen sulphide poisoning can occur in industrial5occupational(oil refining, viscose rayon manufacturing, vulcani7ation of

ru$$er, hydrochloric acid in farm +ells, leather industry, se+age

cleaning, roofing asphalt tan#s, etc), recreational (cleaning of hot

spring reservoirs, caves, sulfur springs, etc), or hospital (plaster

of !aris, etc) settings4 8he first reports date from the th

century +here city se+age cleaners +ere found dead in the

vicinity of the se+ers4 At a concentration of *029 ppm H2S has a

specific odour of rotten eggs4 8his odour is an unrelia$le mar#er

since at higher concentrations (: ** ppm) the gas rapidlycauses paralysis of (the olfactory system resulting in anosmia4 At

concentrations : 9* ppm symptoms are characteri7ed $y

mucositis (con;unctivitis, upper air+ay irritation), nausea and

di77iness, at : 2** ppm pulmonary edema can occur, at : 9**

ppm neurologic pro$lems arise (agitation, sei7ures follo+ed $y

coma), at : *** ppm sudden death can occur4 .ain target

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organs are the central nervous system (C

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*4, pD29 > 1* mmHg (+ith an =iD2of / > E), pCD2+as

42 >4 mmHg, %H 9114' > 9/94 IU5l, lactate 4*' >

14', A? > m-J5l, hemoglo$in 4 > *4/ g5dl, @&C 14 >

4' K *15l, platelets 22* > 1 K *'5l4 Car$oxyhemoglo$in and

methemoglo$in levels (performed in t+o) +ere normal4 Chest ray sho+ed $ilateral nodular opacities in t+o patients (+ith ?CS

59 and .B) and unilateral involvement in one4 C8 scan

confirmed the presence of large air+ay disease in t+o $ut

sho+ed no evidence of roundglass opacities or $ronchieetasis4

&A% fluid sho+ed raised @&C3 mainly polymorphonuclears (!. 2494Under treatment +ith $eta2mimetics and inhalation steroids

lung function tests returned to normal in all except one (fi$rosis)

patient4 All patients could go $ac# to +or# after 9 > 94 months4

Conclusions

Hydrogen sulphide intoxication at concentrations of : *** ppmare rarely seen4 Dn the $asis of our findings +e recommend

aggressive treatment in these cases +ith oxygen supplements $yface mas# or via -88 M .B (if ?CS '), antidotes (

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cases of lethal dose intoxication4