[Suicidal poisoning due to hydrogen sulfide produced by mixing a liquid bath essence containing sulfur and a toilet bowl cleaner containing hydrochloric acid]

A 21-year-old man was found dead in a car. There were 9 empty bottles of 610HAP (a 440 g bottle of a liquid bath essence containing 160-195 g/kg sulfur) and 10 of Sunpole (a 500 mL bottle of a toilet bowl cleaner containing 9.5% HCl) in the car. The car doors were sealed with tape, and there was a strong smell of sulfur in and around the car. GC/MS analysis showed 0.66 microg/mL sulfide and 0.14 micromol/mL thiosulfate in the blood sample. The concentration of thiosulfate in the urine sample was normal. Police investigation concluded that the man killed himself by aspirating hydrogen sulfide that had been produced by mixing 610 HAP and Sunpole. To examine the amount of hydrogen sulfide produced, small portions of these liquids were mixed in a 560-mL volume flask. The results showed that 0.1 mL of each liquid produced 4,950 ppm of hydrogen sulfide, and 0.2 mL of each produced 10,800 ppm. According to these results, if the cabin volume is assumed to be 3,300 L, mixing 120 mL of each liquid produces a lethal level of hydrogen sulfide, i.e., 1,000 ppm. This was a rare suicide case, and it revealed the hazards of mixing of liquid bath essences containing sulfur and toilet bowl cleaners containing hydrochloric acid.

Fatal occupational inhalation of hydrogen sulfide

A young man aged 22 years, a sewer worker by profession, died after massive inhalation of hydrogen sulfide while at work. He was rescued by the emergency services and admitted to the critical care department, where he died due to massive myocardial necrosis less than 24 h after admission. In this case, where the causes of the accident were not clearly established, autopsy and anatomopathologic examination made it possible to confirm the causal lesions which resulted in death and to question the initial version of the circumstances of the accident. Medicolegal investigation was valuable in determining possible liabilities and repercussions on coverage as an industrial accident by the national health insurance system.

Accident due to release of hydrogen sulphide in a manufacturing process of cobalt sulphide - case study

An accident occurs during the manufacture of cobalt sulphide unit due to liberation of hydrogen sulphide. Problems associated with the hydrogen sulphide and the recommended preventive measures have been discussed.

"Death may come on like a stroke of lightening": phenomenological and morphological aspects of fatalities caused by manure gas

Due to the decomposition of biological material, hydrogen sulphide (H2S) is produced. In low concentrations, the well-known smell of "rotten eggs" is associated with H2S. In higher concentrations, H2S is an odourless and colourless gas that may cause rapid loss of consciousness, neurological and respiratory depression and imminent death--"... like a stroke of lightening". Hydrogen sulphide poisoning is an un-common incident that is often associated with colleague fatalities. In this study, 4 fatal accidents with 10 deceased victims are reported and the morphological and phenomenological aspects are presented. In these cases, the morphological findings, namely, discolouration of the livores, pulmonary pathologies and sub-mucosal or sub-serosal congestion bleeding were found in nearly all cases. Also the impending threat for colleagues, first aid helpers and professional rescue teams is demonstrated. The suspicion of a fatal H2S intoxication should be based on a precise scene analysis with respect to the possibility of life-threatening H2S intoxication for the helpers, the typical scent of rotten eggs, which may be noted on the corpses and the abovementioned morphological findings. The diagnosis should be confirmed by a qualitative and, if possible, quantitative analysis of H2S.

Intoxication accidentelle mortelle par hydrogène sulfuré

We report a case of fatal outcome poisoning by massive exposure to hydrogen sulfide of a sewer worker. This rare event was associated with a moderate intoxication of two members of the rescue team. The death was due to asystole and massive lung oedema. Autopsy analysis showed diffuse necrotic lesions in lungs. Hydrogen sulfide is a direct and systemic poison, produced by organic matter decomposition. The direct toxicity mechanism is still unclear. The systemic toxicity is due to an acute toxicity by oxygen depletion at cellular level. It is highly diffusable and potentially very dangerous. At low concentration, rotten egg smell must trigger hydrogen sulfide suspicion since at higher concentration it is undetectable, making intoxication possible. In case of acute intoxication, there is an almost instantaneous cardiovascular failure and a rapid death. Hydrogen sulfide exposure requires prevention measures and more specifically the use of respiratory equipment for members of the rescue team.

Death by sewer gas: case report of a double fatality and review of the literature

Hydrogen sulfide (H2S), the toxic gas associated with the smell of "rotten eggs," is an important cause of work-related sudden death. The gas is particularly insidious due to the unpredictability of its presence and concentration and its neurotoxicity at relatively low concentrations, causing olfactory nerve paralysis and loss of the warning odor. We report a double fatality involving 2 surveyors working near a man-hole, who fell into the sewer and died due to sudden exposure to hydrogen sulfide gas. Key historical, physical, and toxicologic findings are described. Additionally, we present a discussion of the clinical presentations and differential diagnosis, mechanism of injury, metabolism and toxicology, incidence, and scene and safety concerns in fatal hydrogen sulfide exposures.

Fatal hydrogen sulfide poisoning at a dye works

An adult Japanese man (A) entered a pit to remove sludge in a drainage pipe at a dye works in Japan. When he took off a joint of the pipe, the sludge in the pipe flowed into the pit. As he suddenly lost consciousness, three colleagues (B, C, D) entered the pit to rescue him. All of these (A, B, C and D) lost consciousness in the pit, and died soon after the accident. Since hydrogen sulfide gas was detected in the sludge of the pit, gas poisoning was suspected. Toxicological analyses of sulfide and thiosulfate, a metabolite of sulfide, in blood and urine of the victims were made, using the extractive alkylation technique combined with gas chromatography/mass spectrometry. Sulfide and thiosulfate were detected in whole blood of the four workers at levels of 0.32-9.36 mg/l and 0.11-0.23 mmol/l, respectively. These concentrations were at least 6-187 times higher in sulfide and 37-77 times higher in thiosulfate than those in healthy persons, and were similar to values found in fatal cases of hydrogen sulfide poisoning. Thiosulfate was not detected in the urine of four workers, which indicated acute death. Based on these results, all four patients were victims of hydrogen sulfide poisoning, who died soon after the exposure.

Severe hydrogen sulfide exposure in a working adolescent

We describe an occupational exposure to hydrogen sulfide gas in a 16-year-old boy. While cleaning the reoxygenation tank of a fish hatchery, he and an adult supervisor lost consciousness. The adult died, and the adolescent regained consciousness briefly when emergency medical services personnel administered oxygen. At a local emergency department, he was intubated for respiratory distress. He was transferred to a tertiary care facility for additional management and, over the next 2 weeks, had a recovery to normal function. Hydrogen sulfide is a colorless, malodorous gas that results from the decay of organic material. It is a byproduct of industry and agriculture. The mechanism of its toxicity is related primarily to inhibition of oxidative phosphorylation, which causes a decrease in available cellular energy. Although there is some anecdotal evidence to suggest that the early use of hyperbaric oxygen is beneficial, supportive care remains the mainstay of therapy. This report highlights the sources of exposure, management, and need for more stringent application of safety regulations in industries in which adolescents are employed.