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.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
Hydrogen sulfide is a significant occupational health hazard. Education, personal protective equipment, and early treatment are important in improving outcomes.
Gerasimon
Gregg
G
Major, Medical Corps, U.S. Army, Internal Medicine, Womack Army Medical Center, Fort Bragg, North Carolina 28310, USA. gregg.gerasimon@us.army.mil
Bennett
Steven
S
Musser
Jeffrey
J
Rinard
John
J
D000208:Acute Disease; D000328:Adult; D000382:Agricultural Workers' Diseases / Q000097:blood / Q000139:chemically induced* / Q000534:rehabilitation; D001049:Apnea / Q000139:chemically induced; D003612:Dairying; D004531:Eggs; D006801:Humans; D006862:Hydrogen Sulfide / Q000097:blood / Q000506:poisoning*; D002534:Hypoxia, Brain / Q000139:chemically induced / Q000503:physiopathology / Q000534:rehabilitation; D008297:Male; D009422:Nervous System Diseases / Q000097:blood / Q000139:chemically induced* / Q000534:rehabilitation; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D013885:Thiosulfates / Q000097:blood
D013885:Thiosulfates; D006862:Hydrogen Sulfide