All,
There has been a controvery over the years. Some of us in th
e Medical Toxicology/Occupatonal Medicine fields have had anecdotal success
with administration of intravenous sodium nitrite (one of the 3 com
ponents of the Lilly/Pasadena/Taylor Cyanide Antidote Kit). Persona
lly, I have seen some cases of rather dramatic response, but this is an
ecdotal exprience.
There are some animal data suggesting that sodium nitrite is not eff
icacious. In some aminal studies, adminstration of sodium bicarbo
nate seemed to have some effect, although as compared to cyanide poisonin
g which acts by a similar mechanism, patients tend not to have as severe
a metabolic acidosis.
In patients who do not resond to administration of 100% oxygen (by endotrac
heal tube if necessary) and other supportive care (with or without administ
ration of sodium nitrite), there are a few reported cases of survival fol
lowing hyperbaric oxygen therapy (I've personnaly had limited experi
ence with this).
In some large case series, those who were initially rendered uncon
scious from exposure to H2S (the "slaughterhouse sledgehammer effect" at hi
gh airborne levels), and who had regained consciousnes by the time
of hospital arrival have generally fully recovered, while those who were
still unconscious upon hospital arrival have most often died. Ther
e are a few cases of survival with central nervous system damage.
There is a failry large literature on this. I have a reasonable rev
iew on H2S and other systemic asphyxiants that discusses the antidote and H
BO issues:
Hall AH: System Asphyxiant Poisoning, in: Irwin RS, Rip
pe JM (eds), Irwin and Rippe's Intensive Care Medicine, 6th edition.&nb
sp; Wolters Kluwer / Lippincott Williams & Wilkins, Philadelphia
, 2008, pp. 1699-1706. (Note: the 7th edition is in pre
paration, but will not be published for some time yet).
For a further discussion on the controversies of sodium nitrite administrat
ion and good advice on medical treatment for H2S poisoned patients, see:<
BR>
Guidotti TL: Hydrogen Sulfide, in: Shannon MW, B
orron SW, Burns MJ (eds), Haddad and Winchester's Clinical Management o
f Poisoning and Drug Overdose, 4th ed. Saunders Elsevier, 2007
, pp. 1335-1342.
I would be happy to discuss this issue individually with any D-CHAS member
who has questions.
Alan
Alan H. Hall, M.D.
Medical Toxicologist
TCMTS, Inc.
Laramie, WY
Clinical Assistant Professor
Coloraro School of Public Health
Denver, CO
ahalltoxic**At_Symbol_Here**msn.com
Cell Phone: (307) 399-1564
Hi All,
I just had the q uestion posed to me - does anyone know of an antidote to H2S exposure?.&n bsp; This is oil refinery related where a sudden exposure to H2S could ha ppen if something goes wrong with compressors and other pipelines and machi nery. If anyone has knowledge of an antidote, please let me know. I believe that this might have relevance in other places also.
Ken Smith
Retired CIH
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