A fatal work-related poisoning by hydrogen sulfide: report on a case

Case report: Analysis of a case of hydrogen sulfide poisoning in a waste treatment plant

This paper summarizes and analyzes the clinical data of a patient with Occupational hydrogen sulfide poisoning admitted to our hospital on March 4, 2023. On the morning of March 2, 2023, the patient worked at an environmental energy company (waste treatment plant) in Shandong Province for the first time, The job was to flush the sludge from the walls of the sludge treatment tank (anaerobic tank) with a water gun, which can release hydrogen sulfide gas. When the patient was about to start work after entering the tank for about 1 min, he suddenly smelled a harsh and pungent odor, felt dizzy and weak, and then the patient suddenly fainted. After hearing the sound of the patient fainting, the workman waiting at the entrance of the tank immediately called someone to go into the tank and quickly pull the patient out, and sent to the local hospital. In the local hospital, the patient was confused, accompanied by irritability, convulsion and other manifestations, and was treated with sedation and nutritional support. Two days later, the patient's condition did not improve. For further diagnosis and treatment, the patient was transferred to the Department of Poisoning and Occupational Diseases in our hospital. After comprehensive treatment in our hospital, the patient got better and was discharged. Subsequent reexamination and follow-up showed that the patient recovered well. The work unit of the patient did not provide any personal protective equipment. According to the field investigation after the accident, the pipeline around the sludge treatment tank was blocked by sludge, resulting in a large amount of high concentration of H2S accumulated in the tank, causing the patient to faint soon after entering the tank, and his worker should be in the tank for a short time, and no health abnormalities were found. Hydrogen sulfide has a strong irritation to the human body, which can lead to asphyxia or even death in severe cases. The safety prevention and prevention knowledge of hydrogen sulfide poisoning should be popularized among enterprises and workers to reduce the occurrence of such incidents.

Hydrogen sulfide poisoning in forensic pathology and toxicology: mechanism and metabolites quantification analysis

Historically, hydrogen sulfide (H₂S) poisoning has extremely high and irreparable mortality. Currently, the identification of H₂S poisoning needs to combine with the case scene analysis in forensic medicine. The anatomy of the deceased seldom had obvious features. There are also a few reports about H₂S poisoning in detail. As a result, we give a comprehensive analysis of the related knowledge on the forensic aspect of H₂S poisoning. Furthermore, we provide the analytical methods of H₂S and its metabolite-which may assist in H₂S poisoning identification.

Forensic diagnostic approach of peri-volcanic area fatalities: About two cases at piton de la Fournaise

The Piton de la Fournaise, located on the island of Reunion, is a particularly active volcano that gathers many observers during its eruptions. However, this activity, if not supervised, can involve many risks. During the eruption of Piton de la Fournaise in April 2021, two geology students camped in the peri-eruptive zone. They were found dead 48 h later on the surface and were not in the immediate vicinity of a fumarole. The autopsy revealed superficial traumatic injuries, which did not explain the death. Internal examination of both victims showed a nonspecific asphyxia syndrome and hemorrhagic pulmonary edema, with no cause of death identified. Microscopic analysis confirmed the autopsy findings without providing new diagnostic elements. Toxicological analysis revealed abnormally high levels of sulfurous gases (H₂ S and SO₂ ) in the blood and lungs of both victims. The interpretation of all the forensic data allows us to conclude that the death was secondary to volcanic sulfur gas poisoning, despite the atypical context of this event. However, the meteorological conditions of the night of the event may have caused a stagnation of toxic volcanic gases on the ground, with concentrations high enough to cause fatal intoxication in these two persons, although they were not in a confined environment as is usually the case in cases of sulfur poisoning. The dramatic outcome of this event required a rigorous forensic diagnostic approach and reminds us of the need to respect safety conditions in peri-volcanic areas.

Fatal poisoning of four workers in a farm: Distribution of hydrogen sulfide and thiosulfate in 10 different biological matrices

We evaluate the distribution of sulfide and thiosulfate (TS) in biological samples of four dairy farmers died inside a pit connected to a manure lagoon. Autopsies were performed 4 days later. Toxicological analyses of sulfide and TS were made using an extractive alkylation technique combined with gas chromatography/mass spectrometry (GC/MS). Autopsies revealed: multiorgan congestion; pulmonary edema; manure inside distal airways of three of the four victims. Sulfide concentrations were cardiac blood: 0.5-3.0 μg/mL, femoral blood: 0.5-1.2 μg/mL, bile: <0.1-2.2 μg/mL; liver 2.8-8.3 μg/g, lung: 5.0-9.4 μg/g, brain: 2.7-13.9 μg/g, spleen: 3.3-6.3 μg/g, fat: <0.1-1.5 μg/g, muscle: 2.6-3.5 μg/g. TS concentrations were cardiac blood: 2.1-4.9 μg/mL, femoral blood: 2.1-2.3 μg/mL, bile: 2.5-4.4 μg/mL, urine: <0.5-1.8 μg/mL; liver <0.5-2.6, lung: 2.8-5.4 μg/g, brain: <0.5-1.9 μg/g, spleen: 1.2-2.9 μg/g, muscle: <0.5-5.6 μg/g. The cause of death was assessed to be acute poisoning by hydrogen sulfide (H₂S) for all the victims. Manure inhalation contributed to the death of three subjects. The measurement of sulfide and TS concentrations in biological samples contributed to better understand the sequence of the events. Subjects 3 provided the highest concentration of sulfide in brain, thus, supporting the hypothesis of a rapid loss of consciousness and respiratory depression. One by one, the other farmers entered the pit in attempts to rescue the coworkers but collapsed. Despite the rapid death, subject 3 was the only one with TS detectable in urine. This could be due to differences in metabolism of H₂S.

Lethal Hydrogen Sulfide poisoning in open space: An atypical case of asphyxiation of two workers

Hydrogen sulfide is one of the most dangerous toxic gases that has led to the deaths in confined spaces of many workers. We report an atypical case of a fatal accident of H₂S poisoning in an open space when two workers died during the opening of a hatch on a tanker truck filled with leachate water. Despite being outdoors, the two workers, were suddenly and quickly overwhelmed by a lethal cloud of H₂S, which escaped like a geyser from the hatch and hovered over the top of the tanker making it impossible for them to survive. The first operator was engulfed by the sudden flow of lethal gas near the hatch while the second worker, who came to his aid, immediately lost consciousness and fell off the tanker onto the ground. Environmental toxicological analyses were carried out on the air near the hatch and inside the tanker 2h, 20 days and 70 days after the accident. Toxicological analyses on the blood were also carried out but unfortunately, no urine sample was available. The thiosulfate, detected by GC/MS analysis after derivatization of PFBBr, was found to be 0.01 and 0.04mM/L. These values are included in the medium-low lethal values of occupational fatalities involving H₂S reported in the literature.

Hydrogen sulfide inhalation-induced immune damage is involved in oxidative stress, inflammation, apoptosis and the Th1/Th2 imbalance in broiler bursa of Fabricius

Hydrogen sulfide (H₂S) is widely accepted to be a signaling molecule that exhibits some potentially beneficial therapeutic effects at physiological concentrations. At elevated levels, H₂S is highly toxic and has a negative effect on human health and animal welfare. Studies have shown that H₂S exposure induces an immune function in mice, but there are few studies of the effect of continuous H₂S exposure on immune organs in poultry. In this study, one-day-old broilers were selected and exposed to 4 or 20 ppm of H₂S gas for 14, 28 and 42 days of age. After exposure, the bursa of Fabricius (BF) was harvested. The results showed that continuous H₂S exposure reduced the body weight, abdominal fat percentage, and antibody titer in broilers. H₂S exposure also decreased mRNA expression of IgA, IgM and IgG in the broiler BF. A histological study revealed obvious nuclear debris, and a few vacuoles in the BF, and an ultrastructural study revealed mitochondrial and nuclear damage to BF cells after H₂S exposure for 42 d. Terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay suggested H₂S exposure remarkably increased the number of TUNEL positive nuclei and significantly increased apoptotic index. The expression of apoptotic genes also confirmed that H₂S inhalation damaged the broiler BF. Increased cytokines and reduced antioxidant responses were detected in the BF after exposure to H₂S. Cytokines promoted inflammation and caused a Th1/Th2 imbalance. We suggest that continuous H₂S intoxication triggers oxidative stress, inflammation, apoptosis and a Th1/Th2 imbalance in the BF, leading to immune injury in broilers.

Rapid Determination of H2S Poisoning in a Forensic Study Using a Novel Fluorescence Assay Based on Zn/Cu@BSA Nanoclusters

The quantitative determination of H2S in the blood can provide valid evidence for H2S poisoning through occupational exposure. However, known traditional methods for the detection of H2S in blood are time consuming, require complicated pretreatments, and have low sensitivity. In this paper, a new fluorescence sensing assay is proposed for the rapid detection of H2S poisoning in forensic cases based on bovine serum albumin (BSA)-stabilised zinc/copper (Zn/Cu) bi-metal nanoclusters (Zn/Cu@BSA NCs). The as-prepared Zn/Cu@BSA NCs probes have been characterised by UV-vis absorption and fluorescence spectroscopy. The fluorescence of Zn/Cu@BSA NCs can be quenched through specific interactions between HS−/S2− and the Zn2+/Cu2+ bi-metal ions. Under optimised conditions, the fluorescence sensing method was linear in the concentration range of 2.5 nM to 30 mM with 0.69 nM as the limit of detection. Moreover, the practical feasibility of this fluorescence sensing method has also been demonstrated by the analysis of mice blood samples containing different levels of sulfide and human blood samples from forensic cases of H2S poisoning. Compared with gas chromatography/mass spectrometry (GC/MS), this fluorescence sensing method is quite simple, straightforward, and can be accurate for the quantitative determination of H2S poisoning in a few minutes for forensic analysis. Overall, this is the first report of a bi-metal fluorescence sensing assay for detecting H2S poisoning directly in blood. This research may provide a new approach for forensic toxicologists to monitor poisoning by H2S using a fluorescence-sensing method.

Development for the measurement of serum thiosulfate using LC-MS/MS in forensic diagnosis of H2S poisoning

Thiosulfate measurement is crucial to diagnosis of hydrogen sulfide (H2S) poisoning in forensic toxicology. Although GC-MS method is currently regarded as a standard thiosulfate measurement, it requires complicated sample preparation prior to analysis. This study presents a simple, rapid, and highly sensitive method for the quantitative analysis of serum thiosulfate by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). This method is based on selected reaction monitoring and has high sensitivity with a lower quantification limit of 0.5μM. Precision and accuracy of this method meet the basic requirements for quantitative analysis (intra- and inter-day tests have a relative standard deviation of ⩽10.4%; range of analytical recovery is 94.3-102.6%). On the measurements of serum thiosulfate by our developed method, a thiosulfate concentration as 57.5μM was detected clearly in the H2S poisoning case comparing to the non poisoning case in which only a trace amount of thiosulfate was observed.

A gas chromatography-mass spectrometry based study on urine metabolomics in rats chronically poisoned with hydrogen sulfide

Gas chromatography-mass spectrometry (GS-MS) in combination with multivariate statistical analysis was applied to explore the metabolic variability in urine of chronically hydrogen sulfide- (H2S-) poisoned rats relative to control ones. The changes in endogenous metabolites were studied by partial least squares-discriminate analysis (PLS-DA) and independent-samples t-test. The metabolic patterns of H2S-poisoned group are separated from the control, suggesting that the metabolic profiles of H2S-poisoned rats were markedly different from the controls. Moreover, compared to the control group, the level of alanine, d-ribose, tetradecanoic acid, L-aspartic acid, pentanedioic acid, cholesterol, acetate, and oleic acid in rat urine of the poisoning group decreased, while the level of glycine, d-mannose, arabinofuranose, and propanoic acid increased. These metabolites are related to amino acid metabolism as well as energy and lipid metabolism in vivo. Studying metabolomics using GC-MS allows for a comprehensive overview of the metabolism of the living body. This technique can be employed to decipher the mechanism of chronic H2S poisoning, thus promoting the use of metabolomics in clinical toxicology.

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.

Greatly enhanced H2S sensitivity using defect-rich titanium oxide films

Defect-rich titanium oxide films revealed overlayers of chemi-sorbed oxygen, producing a significant enhancement in sensitivity towards H₂S gas with greater stability, better selectivity and quicker recovery.