title: Diagnostics of fatal hydrogen sulfide poisonings.
abstract: BACKGROUND
  Cases of fatal hydrogen sulfide poisonings are rarely presented in forensic medicine practice. They mostly occur in occupational settings and occasionally are mass. Due to occupational poisonings caused by gases, hydrogen sulfide is ranked second regarding frequency-dependent incidence. Hydrogen sulfide at high concentrations is undetectable to human senses resulting in increased risk of fatal poisoning. Such poisonings represent a particular group with respect to their objectification by toxicological analysis.
  
  
  OBJECTIVE
  The aim of this paper is to demonstrate possibilities of laboratory diagnostics of fatal hydrogen sulfide poisonings.
  
  
  METHODS
  The paper provides a retrospective overview of 15 cases of fatal hydrogen sulfide poisonings which occurred in the history of the Institute of Forensic Medicine of the School of Medicine, Comenius University in Bratislava. All cases were completely analysed by morphological and toxicological methods. The samples of blood and pulmonary tissue were examined in the toxicological analysis. The method of analysis of alveolar air was developed by Bauer. An experiment for detection of post-mortem production of hydrogen sulfide in the body was performed.
  
  
  RESULTS
  Morphological findings in all autopsied and analysed cases were similar and nonspecific for poisoning diagnosis. A significant change in possibilities of toxicological analysis occurred in 1968. Since then a direct identification of toxic gas through the analysis of alveolar air has been possible.
  
  
  CONCLUSIONS
  Taking into consideration summarization and comparison of the analysis results of the cases from archive materials of the authors, it is possible to claim that at the workplace in Bratislava a unique objective method of proving this gaseous poison in biological material used so far has been developed. Some negative or unconvincing results of toxicological analysis again refer to pitfalls of diagnostics of hydrogen sulfide poisonings, which must be complex and based upon an efficient collaboration particularly between a medical examiner and toxicologist-analyst together with other bodies complementing the required spectrum of investigated circumstances and clinical data.
authors.affiliation: Institute of Forensic Medicine, School of Medicine, Comenius University and Healthcare Surveillance Authority, Bratislava, Slovakia.
authors.forename: J
authors.initials: J
authors.lastname: Sidlo
authors.forename: M
authors.initials: M
authors.lastname: Bauer
authors.forename: J
authors.initials: J
authors.lastname: Bauerová
authors.forename: J
authors.initials: J
authors.lastname: Valuch
mesh_terms: D000062:Accidents, Occupational; D005554:Forensic Medicine; D006801:Humans; D006862:Hydrogen Sulfide / Q000506:poisoning*
chemical_list: D006862:Hydrogen Sulfide