Reversal of Heart and Respiratory Failure Following Accidental Exposure to Hydrogen Sulfide: Case Report

David Silva, Nuno Correia, Alice Pinheiro, Miguel Marques, Gustavo Barbosa, Carla Melo, Mario Esteves, Augusto Duarte


Risks of exposure to toxic gases are well recognized during work in sewers, the principal hazards resulting from hypoxia due to the accumulation of methane, carbon dioxide, or hydrogen sulfide and explosive risk as a result of flammable gases. Hydrogen sulfide (H<sub>2</sub>S) is a colourless rotten egg odour gas resulting from organic matter decomposition. The severity of H<sub>2</sub>S intoxication depends on the concentration and duration of exposure and the outcome may be fatal. We report the case of a 59-year-old male patient who was acutely exposed to sewers gases following an accidental leak in a swine facility nearly eighteen hours before. He presented to the emergency room with respiratory complaints and chest pain, and rapidly developed a multi-organ dysfunction syndrome with severe cardio-respiratory failure. No methaemoglobinemia was detected and H<sub>2</sub>S was presumed to be the major implicated toxic substance. Treatment strategy relied mostly on supportive measures with a successful outcome. Approach to victims of exposure to sewers gases should recall the strong possibility of poisoning by H<sub>2</sub>S, a life-threatening condition. Since laboratorial dosing of sulfide compounds is not readily available, the initial approach is based on a high clinical suspicion. H<sub>2</sub>S direct toxicity and cellular hypoxic induction may rapidly lead to multi-organic dysfunction and death. Evidence from case reports suggests that early treatment with nitrites, hyperbaric oxygen therapy and hydroxocobalamin may be beneficial. To the present date, supportive treatment remains the mainstay of care.

J Med Cases. 2012;3(1):25-30


Hydrogen sulfide; Poisoning; Sewers gases

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