Noxious gas exposure in the outback: two cases of hydrogen sulfide toxicity

Effects of long-term exposure to hydrogen sulfide on human red blood cells

Background:

Hydrogen sulfide (H2S) exhibits both physiological and toxicological roles in the biological systems. Acute exposure to high levels of H2S is life threatening while longterm exposure to ambient levels of H2S elicits human health effects.

Objective:

To study the harmful effects of long-term exposure to low levels of H2S on human blood cells.

Methods:

110 adult workers from Iran who were occupationally exposed to 0–90 ppb H2S for 1–30 years were studied. The participants aged between 18 and 60 years and were exposed directly or indirectly to sulfur compounds (exposed group). The origin of H2S was natural gas processing plants. A control group consisting of 110 males who were not in contact with H2S was also studied. For all participants, hematological profile including total hemoglobin and red blood cell count and sulfhemoglobin, methemoglobin levels were measured.

Results:

Among all parameters evaluated in this study the mean methemoglobin and sulfhemoglobin levels were significantly higher among workers who were exposed to sulfur compounds than the control group. Major differences throughout the study period for sulfhemoglobinemia among exposed groups were observed.

Conclusion:

Long-term exposure to even low levels of H2S in workplaces may have potential harmful effects on human health.

Antagonism of Acute Sulfide Poisoning in Mice by Nitrite Anion without Methemoglobinemia

There are currently no FDA-approved antidotes for H2S/sulfide intoxication. Sodium nitrite, if given prophylactically to Swiss Webster mice, was shown to be highly protective against the acute toxic effects of sodium hydrosulfide (∼LD40 dose) with both agents administered by intraperitoneal injections. However, sodium nitrite administered after the toxicant dose did not detectably ameliorate sulfide toxicity in this fast-delivery, single-shot experimental paradigm. Nitrite anion was shown to rapidly produce NO in the bloodstream, as judged by the appearance of EPR signals attributable to nitrosylhemoglobin and methemoglobin, together amounting to less than 5% of the total hemoglobin present. Sulfide-intoxicated mice were neither helped by the supplemental administration of 100% oxygen nor were there any detrimental effects. Compared to cyanide-intoxicated mice, animals surviving sulfide intoxication exhibited very short knockdown times (if any) and full recovery was extremely fast (∼15 min) irrespective of whether sodium nitrite was administered. Behavioral experiments testing the ability of mice to maintain balance on a rotating cylinder showed no motor impairment up to 24 h post sulfide exposure. It is argued that antagonism of sulfide inhibition of cytochrome c oxidase by NO is the crucial antidotal activity of nitrite rather than formation of methemoglobin.

Hyperbaric oxygen therapy in the management of two cases of hydrogen sulfide toxicity from liquid manure

Hydrogen sulfide is a potent lethal gas. Supportive care, nitrite therapy and hyperbaric oxygen are the treatment modalities reported in the literature in cases of hydrogen sulfide exposure. We describe an industrial exposure in which 6 workers inhaled high concentrations of hydrogen sulfide when they entered a closed spreader tank partially filled with liquid swine manure. Five of the 6 lost consciousness, and 2 were agitated and poorly responsive on arrival to the emergency department despite having already received high-flow oxygen for nearly 1 hour. These 2 patients received nitrite therapy followed by orotracheal intubation and hyperbaric oxygen. All patients were discharged home without sequelae after short stays in hospital. The emergency management of hydrogen sulfide exposure is briefly reviewed.

Hydrogen sulfide intoxication

Hydrogen sulfide (H2S) is a hazard primarily in the oil and gas industry, agriculture, sewage and animal waste handling, construction (asphalt operations and disturbing marshy terrain), and other settings where organic material decomposes under reducing conditions, and in geothermal operations. It is an insoluble gas, heavier than air, with a very low odor threshold and high toxicity, driven by concentration more than duration of exposure. Toxicity presents in a unique, reliable, and characteristic toxidrome consisting, in ascending order of exposure, of mucosal irritation, especially of the eye ("gas eye"), olfactory paralysis (not to be confused with olfactory fatigue), sudden but reversible loss of consciousness ("knockdown"), pulmonary edema (with an unusually favorable prognosis), and death (probably with apnea contributing). The risk of chronic neurcognitive changes is controversial, with the best evidence at high exposure levels and after knockdowns, which are frequently accompanied by head injury or oxygen deprivation. Treatment cannot be initiated promptly in the prehospital phase, and currently rests primarily on supportive care, hyperbaric oxygen, and nitrite administration. The mechanism of action for sublethal neurotoxicity and knockdown is clearly not inhibition of cytochrome oxidase c, as generally assumed, although this may play a role in overwhelming exposures. High levels of endogenous sulfide are found in the brain, presumably relating to the function of hydrogen sulfide as a gaseous neurotransmitter and immunomodulator. Prevention requires control of exposure and rigorous training to stop doomed rescue attempts attempted without self-contained breathing apparatus, especially in confined spaces, and in sudden release in the oil and gas sector, which result in multiple avoidable deaths.

The message in the air: hydrogen sulfide metabolism in chronic respiratory diseases

Hydrogen sulfide (H(2)S) is an important gasotransmitter in the mammalian respiratory system. The enzymes that produce H(2)S - mainly cystathionine-β-synthase and cystathionine-γ-lyase - are expressed in pulmonary and airway tissues. Endogenous H(2)S participates in the regulation of the respiratory system's physiological functions and pathophysiological alterations, such as chronic obstructive pulmonary disease, asthma, pulmonary fibrosis and hypoxia-induced pulmonary hypertension, to name a few. The cellular targets of H(2)S in the respiratory system are diverse, including airway smooth muscle cells, epithelial cells, fibroblasts, and pulmonary artery smooth muscle cells. H(2)S also regulates respiratory functions such as airway constriction, pulmonary circulation, cell proliferation or apoptosis, fibrosis, oxidative stress, and neurogenic inflammation. Cross-talk between H(2)S and other gasotransmitters also affects the net outcome of lung function. The metabolism of H(2)S in the lungs and airway may serve as a biomarker for specific respiratory diseases. It is expected that strategies targeted at the metabolism and function of H(2)S will prove useful for the prevention and treatment of selective chronic respiratory diseases.

Myocardial and lung injuries induced by hydrogen sulfide and the effectiveness of oxygen therapy in rats

OBJECTIVE

To study myocardial and lung injuries initiated by hydrogen sulfide, and evaluate the role and effectiveness of normobaric and hyperbaric oxygen (HBO) treatment in rats.

METHODS

One hundred healthy male Wistar rats were randomly divided into five groups: A: Normal control group (no H2S); B: H2S-exposed group; C: H2S+33% oxygen treatment group; D: H2S+50% oxygen treatment group; E: H2S+HBO group. The rats in groups C, D and E were exposed to H2S in an exposure chamber (1 m3) and were made to inhale 300 ppm hydrogen sulfide for 60 min, and then they were subjected to normobaric or HBO therapy. Normobaric oxygen was at concentrations of 33% or 50%, HBO was for 100 min including compression and decompression; the rats in group A inhaled air under the same conditions. Blood was sampled immediately after the experiment for analysis of arterial blood gases, myocardial enzymes and cardiac troponin I. Lung was rapidly removed to be made into tissue homogenates and then cytochrome c oxidase activity was measured; myocardial and lung ultrastructural changes were observed by electron microscopy.

RESULTS

Arterial blood gases: partial pressure of O2 (mmHg) (Group A, 97.6 ± 8.38; B, 76.5 ± 6.95*; C, 83.2 ± 2.66*; D, 86.20 ± 10.75*; E, 93.50 ± 4.97: *p < 0.01 compared to group A) was significantly lower than that in group in all but HBO rats. For myocardial enzymes and cardiac troponin I every parameter in groups B and C was significantly higher than that in group A (p<0.01),with no difference in D and E. Cytochrome c oxidase activity (u/mg) of lung tissue was reduced compared to group A after all treatments (A, 1.76 ± 0.02; B, 0.36 ± 0.04; C, 0.50 ± 0.12; D, 0.56 ± 0.07; E, 0.68 ± 0.05 (A vs. B p < 0.01; B vs. C,D,E p < 0.05 or p < 0.01), with a graded effect of oxygen dose in C, D and E. Pathological changes: (1) Myocardium - Mitochondrial swelling and autolysis with blurred or broken cristae was observed in the myocardium of H2S-exposed group; in group E, mitochondrial structure was basically normal, and clear cristae were found. (2) Lung tissue - In H2S-exposed group, alveolar epithelial cells disappeared, vacuolization of the organelle occurred, nuclear membrane was irregular and marginal condensation of heterochromatin was present; nucleus showed relatively normal morphology in group E, although some vacuoles still persisted within them.

CONCLUSIONS

HBO therapy can effectively improve arterial oxygen partial pressure, and significantly reduce myocardial damage, as well as potentially relieve lung injury in this model. Further work in humans appears warranted.

Hydrogen Sulfide

Hydrogen sulfide is a relatively common, frequently lethal, and unique occupational hazard for which research since 1990 has uncovered many anomalies and subtleties and a previously unsuspected physiological role for the endogenous agent. The result has been uncertainty and misunderstanding, particularly for persons new to the literature. This review addresses evidence that settles past controversies, guides practical issues in evaluating human toxicity, addresses unresolved issues involving chronic exposure, and points the way to a deeper understanding of the agent and its effects.

Hydrogen sulfide exposure in an adult male

Hydrogen sulfide (H(2)S) is responsible for many incidents of occupational toxic exposure, especially in the petroleum industry. The clinical effects of H(2)S depend on its concentration and the duration of exposure. H(2)S is immediately fatal when concentrations are over 500-1000 parts per million (ppm) but exposure to lower concentrations, such as 10-500 ppm, can cause various respiratory symptoms that range from rhinitis to acute respiratory failure. H(2)S may also affect multiple organs, causing temporary or permanent derangements in the nervous, cardiovascular, renal, hepatic, and hematological systems. We present a case of occupational exposure to H(2)S leading to multi-organ involvement, acute respiratory failure, organizing pneumonia, and shock resembling acute sepsis. The patient also developed mild obstructive and restrictive pulmonary disease and peripheral neuropathy.

Acute hydrogen sulfide poisoning in a dairy farmer

INTRODUCTION. Hydrogen sulfide is a lipid-soluble gas produced in occupational settings and from decaying organic matter. We present a 36-year-old man who developed acute respiratory arrest from hydrogen sulfide poisoning while performing work as a dairy farmer.

CASE REPORT

The subject entered a poorly ventilated tank containing degrading eggs and, within seconds, collapsed. Coworkers were able to extract him within minutes but he was apneic. He was intubated by emergency medical services and subsequently managed with supportive care in the intensive care unit. Upon admission, a powerful rotten egg scent was noted and a hydrogen sulfide poisoning was suspected. Serum analysis for the presence of thiosulfate confirmed the diagnosis. Nitrite therapy was not administered as the subject arrived outside of the therapeutic window of effectiveness and showed evidence of excellent oxygenation. His examinations following arrival were consistent with an anoxic brain injury which slowly improved several months after the incident with intensive neuro-rehabilitation.

DISCUSSION

Hydrogen sulfide is a mitochondrial toxin and inhibits cytochrome-aa(3) and prevents cellular aerobic metabolism. Therapies for toxic exposures include removal from the contaminated environment, ventilation with 100% oxygen, and nitrite therapy if administered immediately after exposure. Hyperbaric oxygen (HBO) therapy has anecdotal support and remains controversial.

CONCLUSION

Hydrogen sulfide is a significant occupational health hazard. Education, personal protective equipment, and early treatment are important in improving outcomes.

Mechanism and treatment of sulfide-induced coma: a rat model

Sodium hydrosulfide and dimethylsulfide duplicate the effects of hydrogen sulfide in causing coma in Sprague-Dawley rats and are additive for lethality. Nitrite, pyruvate and dithiothreitol had no significant effect on coma or lethality but bicarbonate with and without glucose reduced duration of coma. This finding suggests an antidotal treatment.