title: [Fatal calcium polysulfide overdose presenting corrosive chemical injury of esophagus and sulf-hemoglobinemia].
abstract: A-79-year-old woman ingested a cup of unknown violet agricultural solution intentionally. She was vomiting and smelt of sulfur. Arterial blood gas showed metabolic acidosis and marked cyanosis regardless of relatively high PaO2, caused by sulfhemoglobinemia. A nasogastric tube could not be inserted because of marked stenosis caused by endoscopically proven severe corrosive chemical injury (burn) of esophagus. Considering the smell and the clinical presentation, we concluded that the causative agent was calcium polysulfide or lime-sulphur solution, a common agricultural product used as a fungicide. Despite supportive therapy including infusion of NaNO2, the patient expired 4.5 hours after ingestion. Calcium polysulfide ingestions cause direct injury to the upper gastrointestinal tract, and react with gastric HCl producing poisonous H2S gas, which interferes cytochrome oxidase activity, developing tissue hypoxia, shock, and metabolic acidosis. Sulfhemoglobin is also produced causing severe cyanosis.
authors.affiliation: Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kiyota
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Suzuki
authors.forename: Takuya
authors.initials: T
authors.lastname: Adachi
authors.forename: Akiko
authors.initials: A
authors.lastname: Nonaka
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Nishigawa
authors.forename: Yuuichi
authors.initials: Y
authors.lastname: Hamabe
mesh_terms: D000368:Aged; D002057:Burns, Chemical; D017610:Calcium Compounds / Q000506:poisoning*; D062787:Drug Overdose; D004940:Esophageal Stenosis / Q000139:chemically induced; D004941:Esophagitis / Q000139:chemically induced*; D004947:Esophagus / Q000293:injuries*; D017809:Fatal Outcome; D005260:Female; D005659:Fungicides, Industrial / Q000506:poisoning*; D005740:Gases; D006801:Humans; D006862:Hydrogen Sulfide / Q000506:poisoning; D012769:Shock / Q000139:chemically induced; D013406:Suicide, Attempted; D013436:Sulfhemoglobinemia / Q000139:chemically induced*; D013440:Sulfides / Q000506:poisoning*; D013885:Thiosulfates / Q000506:poisoning*
chemical_list: D017610:Calcium Compounds; D005659:Fungicides, Industrial; D005740:Gases; D013440:Sulfides; D013885:Thiosulfates; C033907:calcium sulfide; D006862:Hydrogen Sulfide