Medical Management Guidelines for Sulfur Dioxide
(SO2)
CAS#: 7446-09-5
UN#: 1079
PDF Versionpdf icon[178 KB]
Synonyms include sulfur oxide, sulfurous acid anhydride, sulfurous anhydride, and sulfurous oxide.
- Persons exposed only to sulfur dioxide gas pose no risk
of secondary contamination. Persons whose skin or clothing
is contaminated with liquid sulfur dioxide can secondarily
contaminate rescuers by direct contact or through off-gassing
of vapor.
- At room temperature, sulfur dioxide is a nonflammable,
colorless gas that is heavier than air. Its strong, pungent
odor and irritating properties usually provide adequate
warning of its presence.
- Sulfur dioxide is readily absorbed through the upper respiratory
tract; no data were located regarding dermal absorption.
Sulfur dioxide is present in some foods; therefore, oral
ingestion, although insignificant, is possible.
General Information
Description
At room temperature, sulfur dioxide is a nonflammable, colorless gas with a very strong, pungent odor. Most people can smell sulfur dioxide at levels of 0.3 to 1 ppm. It is handled and transported as a liquefied compressed gas. It easily dissolves in water. The liquid is heavier than water. Although sulfur dioxide does not burn in air, cylinders of compressed liquid can explode in the heat of a fire.
Routes of Exposure
Inhalation
Inhalation is the major route of exposure
to sulfur dioxide. The odor threshold is 5 times lower than
the OSHA PEL (5 ppm). Most exposures are due to air pollution,
and this has both short-term and chronic health consequences
for people with lung disease. Inhaled sulfur dioxide readily
reacts with the moisture of mucous membranes to form sulfurous
acid (H2SO3), which is a severe irritant.
People with asthma can experience increased airway resistance
with sulfur dioxide concentrations of less than 0.1 ppm when
exercising. Healthy adults experience increased airway resistance
at 5 ppm, sneezing and coughing at 10 ppm, and bronchospasm
at 20 ppm. Respiratory protection is required for exposures
at or above 20 ppm. Exposures of 50 to 100 ppm may be tolerated
for more than 30 to 60 minutes, but higher or longer exposures
can cause death from airway obstruction. Sulfur dioxide is
heavier than air; thus, exposure in poorly ventilated, enclosed,
or low-lying areas can result in asphyxiation.
Children exposed to the same levels
of sulfur dioxide as adults may receive a larger dose because
they have greater lung surface area:body weight ratios and
increased minute volumes:weight ratios. In addition, they
may be exposed to higher levels than adults in the same location
because of their short stature and the higher levels of sulfur
dioxide found nearer to the ground and because they are slow
to leave the site of an exposure.
Skin/Eye Contact
Exposures of 10 to 20 ppm cause irritation
to mucous membranes. Direct contact with escaping compressed
gas or liquid sulfur dioxide can produce severe corneal damage
and frostbite injury to the skin. No data were located regarding
dermal absorption.
Ingestion
Ingestion of sulfur dioxide is unlikely
because it is a gas at room temperature. Sulfur dioxide is
used in small amounts as a food and wine preservative. Highly
sensitive asthmatic individuals can develop bronchospasm after
eating foods or drinking wine preserved with sulfur dioxide
or other sulfur preservatives.
Sources/Uses
Sulfur dioxide gas is released primarily
from the combustion of fossil fuels (75% to 85% of the industrial
sources), the smelting of sulfide ores, volcanic emissions,
and several other natural sources. It is a U.S. Environmental
Protection Agency (EPA) priority air pollutant, but has many
industrial and agricultural uses. It is sometimes added as
a warning marker and fire retardant to liquid grain fumigants.
Approximately 300,000 tons are used each year to manufacture
hydrosulfites and other sulfur-containing chemicals (40%);
to bleach wood pulp and paper (20%); to process, disinfect,
and bleach food (16%); for waste and water treatment (10%);
in metal and ore refining (6%); and in oil refining (4%).
Toxic amounts of sulfur dioxide can be released from the preservative
chemical metabisulfite in the presence of water and acid.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 5 ppm (averaged over an 8-hour workshift)
NIOSH IDLH (immediately dangerous to
life or health) = 100 ppm
AIHA ERPG-2 (maximum airborne concentration
below which it is believed that nearly all persons could be
exposed for up to 1 hour without experiencing or developing
irreversible or other serious health effects or symptoms that
could impair their abilities to take protective action) =
3 ppm
Physical Properties
Description: colorless gas at
room temperature, colorless liquid when pressurized or cooled.
Warning properties: pungent odor
is usually adequate to warn of acute exposure. Most people
can detect sulfur dioxide at levels of 1 to 3 ppm (1 ppm is
equivalent to 2.62 mg/m3).
Molecular weight: 64.06 daltons
Boiling point (760 mm Hg): 14.0°F
(-10.0°C)
Freezing point: -99.4°F (-72.7°C)
Vapor pressure: 2,538 mm Hg at
70.0EF (21.1°C)
Vapor density: 1.43 g/mL (water
= 1.00)
Water solubility: soluble in water
(11.3 g/100 mL at 68°F [20°C])
Flammability: nonflammable
Incompatibilities
Sulfur dioxide dissolves in water or
steam to form sulfurous acid. Liquid sulfur dioxide corrodes
iron, brass, copper, and some forms of plastic and rubber.
Many metals, including zinc, aluminum, cesium, and iron, incandesce
and/or ignite in unheated sulfur dioxide. Sulfur dioxide reacts
explosively when it comes in contact with sodium hydride.
Sulfur dioxide ignites when it is mixed with lithium acetylene
carbide diamino or lithium acetylide ammonia.
Health Effects
- Sulfur dioxide is severely irritating to the eyes, mucous
membranes, skin, and respiratory tract. Bronchospasm, pulmonary
edema, pneumonitis, and acute airway obstruction can occur.
- Inhalation exposure to very low concentrations of sulfur
dioxide can aggravate chronic pulmonary diseases, such as
asthma and emphysema. Certain highly sensitive asthmatics
may develop bronchospasm when exposed to sulfur dioxide
or sulfite-preserved foods.
- Sulfur dioxide reacts with water in the upper airway to
form hydrogen, bisulfite, and sulfite, all of which induce
irritation. As a result, reflex bronchoconstriction increases
airway resistance.
Acute Exposure
Sulfur dioxide dissolves in the moisture
on skin, eyes, and mucous membranes to form sulfurous acid,
an irritant and inhibitor of mucociliary transport. Most of
the inhaled sulfur dioxide is detoxified by the liver to sulfates
and excreted in the urine. The bisulfite ion produced when
sulfur dioxide reacts with water is likely to be the main
initiator of sulphur dioxide-induced bronchoconstriction.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
Respiratory
Sulfur dioxide respiratory irritation
induces symptoms such as sneezing, sore throat, wheezing,
shortness of breath, chest tightness, and a feeling of suffocation.
Reflex laryngeal spasm and edema can cause acute airway obstruction.
Bronchospasm, pneumonitis, and pulmonary edema can occur.
Some individuals are very susceptible
to the presence of sulfur dioxide and overreact to concentrations
which, in most people, elicit a much milder response. This
hyperreactive response occurs the first time the individual
is exposed and is therefore not an acquired immune or "hypersensitivity"
response.
Acclimatization (a physiological adjustment
of the individual to environmental changes) may also occur
in up to 80% of exposed individuals. This is not necessarily
beneficial although exposure may become less subjectively
objectionable upon continuous or repeated exposure.
Asthmatics who are sensitive to sulfites
in food can develop bronchospasm or an anaphylactoid reaction.
Sulfur dioxide, along with other components of air pollution,
can exacerbate chronic cardiopulmonary disease.
Exposure to high concentrations of sulfur
dioxide can lead to Reactive Airway Dysfunction Syndrome (RADS),
a chemically- or irritant-induced type of asthma.
Children may be more vulnerable to corrosive
agents than adults because of the relatively smaller diameter
of their airways. Children also may be more vulnerable because
of relatively increased minute ventilation per kg and failure
to evacuate an area promptly when exposed.
Dermal
Sulfur dioxide is a severe skin irritant
causing stinging pain, redness, and blisters, especially on
mucous membranes. Skin contact with escaping compressed gas
or liquid sulfur dioxide can cause frostbite and irritation
injury.
Because of their relatively larger surface
area: body weight ratio, children are more vulnerable to toxicants
that affect the skin.
Ocular
Conjunctivitis and corneal burns can result from the irritant effect of sulfur dioxide vapor or escaping compressed gas, and from direct exposure to the liquid.
Gastrointestinal
Nausea, vomiting, and abdominal pain have been reported after inhalation exposure to moderate to high doses of sulfur dioxide.
Potential Sequelae
High-level acute exposures have resulted
in pulmonary fibrosis, chronic bronchitis, and chemical bronchopneumonia
with bronchiolitis obliterans. Bronchospasm can be triggered
in individuals who have underlying lung disease, especially
those who have asthma and emphysema. Rarely, new onset airway
hyperreactivity, known as reactive airways dysfunction syndrome
(RADS), develops in patients without prior bronchospasm.
Chronic Exposure
Chronic exposure can result in an altered
sense of smell (including increased tolerance to low levels
of sulfur dioxide), increased susceptibility to respiratory
infections, symptoms of chronic bronchitis, and accelerated
decline in pulmonary function. Chronic exposure may be more
serious for children because of their potential longer life
span.
Carcinogenicity
The International Agency for Research
on Cancer (IARC) assigned sulfur dioxide to Group 3, not classifiable
as to its carcinogenicity to humans.
Reproductive and Developmental Effects
Sulfur dioxide is not included in Reproductive
and Developmental Toxicants, a 1991 report published by
the U.S. General Accounting Office (GAO) that lists 30 chemicals
of concern because of widely acknowledged reproductive and
developmental consequences. There are no known reproductive
or developmental effects of sulfur dioxide alone by any route
of exposure. There is no conclusive evidence that sulfur dioxide
is a genotoxin in humans.
Prehospital Management
- Persons exposed only to sulfur dioxide gas pose no risk
of secondary contamination to rescuers. Persons whose skin
or clothing is contaminated with liquid sulfur dioxide can
secondarily contaminate response personnel by direct contact
or through off-gassing of vapor.
- Sulfur dioxide is severely irritating to the eyes, mucous
membranes, skin, and respiratory tract. Exposure to high
levels can cause pulmonary edema, bronchial inflammation
and laryngeal spasm and edema with possible airway obstruction.
- There is no antidote for sulfur dioxide. Treatment consists
of support of respiratory and cardiovascular functions.
Hot Zone
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if the rescuers have not been trained
in its use, call for assistance from a local or regional hazardous
materials (HAZMAT) team or other properly equipped response
organization.
Rescuer Protection
Inhaled sulfur dioxide vapor is readily
absorbed and is a potent respiratory tract irritant, causing
mild irritation even at low doses. Escaping compressed gas
or liquid sulfur dioxide on the skin or eyes can cause frostbite
injury and irritation. Dermal absorption is negligible.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of sulfur dioxide gas.
Skin Protection: Fully encapsulated
chemical-protective clothing is recommended because sulfur
dioxide can cause skin irritation and burns.
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Maintain adequate circulation.
Provide supplemental oxygen if cardiopulmonary compromise
is suspected. If trauma is suspected, manually maintain cervical
immobilization and apply a cervical collar and a backboard
when feasible. Apply direct pressure to stop any heavy bleeding.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk should be removed on backboards or gurneys.
If these are not available, carefully carry or drag victims
to safety.
Consider appropriate management of chemically
contaminated children, such as measures to reduce separation
anxiety if a child is separated from a parent or other adult.
Decontamination Zone
Patients exposed only to sulfur dioxide
gas who have no eye or skin irritation do not need decontamination.
They may be transferred immediately to the Support Zone. Other
patients will require decontamination as described below.
Rescuer Protection
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that required in the Hot
Zone (described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Maintain adequate circulation.
Provide supplemental oxygen if cardiopulmonary compromise
is suspected. If trauma is suspected, manually maintain cervical
immobilization and apply a cervical collar and a backboard
when feasible. Administer supplemental oxygen as required.
Assist ventilation with a bag-valve-mask device if necessary.
Apply direct pressure to control any heavy bleeding.
Basic Decontamination
Rapid skin decontamination is critical.
Victims who are able may assist with their own decontamination.
Remove contaminated clothing and personal belongings and place
them in double plastic bags.
Gently wash exposed skin and hair with
copious amounts of water (preferably under a shower). Use
caution to avoid hypothermia when decontaminating children
or the elderly. Use blankets or warmers when appropriate.
Irrigate exposed eyes with plain water
or saline for at least 5 minutes. Remove contact lenses
if they are easily removable without additional trauma to
the eye. If pain or injury is evident, continue irrigation
while transferring the victim to the Support Zone.
Consider appropriate management of chemically
contaminated children at the exposure site. Also, provide
reassurance to the child during decontamination, especially
if separation from a parent occurs. If possible, seek assistance
from a child separation expert.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone, above). Victims
who have undergone decontamination or have been exposed only
to sulfur dioxide gas pose no serious risk of secondary contamination
to rescuers. In such cases, Support Zone personnel require
no specialized protective gear.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard when feasible.
Ensure adequate respiration and pulse. Administer supplemental
oxygen as required and establish intravenous access if necessary.
Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Sulfur dioxide poisoning is not known to
pose additional risk during the use of bronchial or cardiac
sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
If evidence of shock or hypotension
is observed begin fluid administration. For adults, bolus
1,000 mL/hour intravenous saline or lactated Ringer's solution
if blood pressure is under 80 mm Hg; if systolic pressure
is over 90 mm Hg, an infusion rate of 150 to 200 mL/hour is
sufficient. For children with compromised perfusion administer
a 20 mL/kg bolus of normal saline over 10 to 20 minutes, then
infuse at 2 to 3 mL/kg/hour.
Transport to Medical Facility
Only decontaminated patients or patients
not requiring decontamination should be transported to a medical
facility. "Body bags" are not recommended.
Report the condition of the patient,
treatment given, and estimated time of arrival at the medical
facility to the base station and the receiving medical facility.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
Patients who have histories or evidence
suggesting significant exposure (e.g., severe or persistent
cough or dyspnea, or chemical burns) should be transported
to a medical facility for evaluation. Patients who have a
history of chronic pulmonary disease should be clinically
evaluated for airflow obstruction.
Patients who have symptoms of mild or
transient skin, nose, or eye irritation may be discharged
from the scene after their names, addresses, and telephone
numbers are recorded. They should be advised to rest and to
seek medical care promptly if symptoms develop or recur (see
Patient Information Sheet below).
Emergency Department Management
- Persons exposed only to sulfur dioxide gas pose no risk
of secondary contamination to rescuers. Persons whose skin
or clothing is contaminated with liquid sulfur dioxide can
secondarily contaminate response personnel by direct contact
or through off-gassing of vapor.
- Sulfur dioxide is a severe irritant to the respiratory
tract, eyes, mucous membranes, and skin. Exposure to high
doses can cause pulmonary edema, bronchial inflammation,
and laryngeal spasm and edema with possible airway obstruction.
- There is no antidote for sulfur dioxide. Treatment consists
of support of respiratory and cardiovascular functions.
Decontamination Area
Previously decontaminated patients and
those exposed only to sulfur dioxide gas who have no skin
or eye irritation may be transferred immediately to the Critical
Care Area. Others require decontamination as described below.
Be aware that use of protective equipment
by the provider may cause fear in children, resulting in decreased
compliance with further management efforts.
Emergency room personnel should examine
children's mouth because of the frequency of hand-to-mouth
activity among children.
ABC Reminders
Evaluate and support the airways, breathing,
and circulation. Children may be more vulnerable to corrosive
agents than adults because of the relatively smaller diameter
of their airways. Provide supplemental oxygen if cardiopulmonary
compromise is suspected. In cases of respiratory compromise
secure airway and respiration via endotracheal intubation.
If not possible, surgically create an airway.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Sulfur dioxide poisoning is not known to
pose additional risk during the use of bronchial or cardiac
sensitizing agents.
Consider racemic epinephrine aerosol for children who develop
stridor. Dose 0.25-0.75 mL of 2.25% racemic epinephrine solution
in 2.5 cc water, repeat every 20 minutes as needed, cautioning
for myocardial variability.
Patients who are comatose, hypotensive,
or are having seizures or cardiac arrhythmias should be treated
in the conventional manner.
Basic Decontamination
Patients who are able may assist with
their own decontamination.
Because sulfur dioxide can cause burns,
ED staff should don chemical-resistant jumpsuits (e.g., of
Tyvek or Saranex) or butyl rubber aprons, rubber gloves, and
eye protection if the patient's clothing or skin is wet. After
the patient has been decontaminated, no special protective
clothing or equipment is required for ED personnel.
Quickly remove contaminated clothing
while gently washing the skin with water (preferably under
a shower). Double-bag the contaminated clothing and personal
belongings. Sulfur dioxide reacts with body moisture to form
sulfurous and sulfuric acids; therefore, chemical burns are
likely. Handle burned skin with caution.
Flush exposed or irritated eyes with
plain water or saline for at least 5 minutes. Remove
contact lenses if easily removable without additional trauma
to the eye. If pain or injury is evident, continue irrigation
while transferring the victim to the Critical Care Area. An
ophthalmic anesthetic, such as 0.5% tetracaine, might be necessary
to alleviate blepharospasm, and lid retractors might be required
to allow adequate irrigation under the eyelids.
Critical Care Area
Be certain that appropriate decontamination
has been carried out (see Decontamination Area, above).
ABC Reminders
Evaluate and support the airways, breathing,
and circulation as in ABC Reminders above. Children may be
more vulnerable to corrosive agents than adults because of
the relatively smaller diameter of their airways. Establish
intravenous access in seriously ill patients. Continuously
monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or are having seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory complaints. Treat patients
who have bronchospasm with aerosolized bronchodilators. The
use of bronchial sensitizing agents in situations of multiple
chemical exposures may pose additional risks. Consider the
health of the myocardium before choosing which type of bronchodilator
should be administered. Cardiac sensitizing agents may be
appropriate; however, the use of cardiac sensitizing agents
after exposure to certain chemicals may pose enhanced risk
of cardiac arrhythmias (especially in the elderly). Sulfur
dioxide poisoning is not known to pose additional risk during
the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Use of steroids to prevent or treat chemical
pneumonitis and pulmonary edema is controversial. Antibiotics
should be used as indicated to control infection. Damaged
lower respiratory tissue might be more susceptible to infection.
Skin Exposure
Escaping compressed gas or liquid sulfur
dioxide can cause frostbite. If frostbite is present, treat
affected areas by rewarming in a water bath at a temperature
of 104 to 107.6°F (40 to 42°C) for 20 to 30 minutes
and continue until a flush has returned to the affected area.
If chemical burns are present, treat as thermal burns.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
that affect the skin.
Eye Exposure
Continue irrigation for at least 15 minutes
or until the pH of the conjunctival fluid has returned to
normal. Test visual acuity. Examine the eyes for conjunctival
or corneal damage and treat appropriately. Immediately consult
an ophthalmologist for patients who have suspected severe
corneal injuries.
Antidotes and Other Treatments
There is no antidote for sulfur dioxide.
Treatment is supportive of respiratory function.
Laboratory Tests
Routine laboratory studies include chest
radiography and pulse oximetry (or ABG measurements).
Disposition and Follow-up
Consider hospitalizing symptomatic patients
who have evidence of respiratory distress or significant skin
burns.
Pulmonary injury might continue to evolve
over 18 to 24 hours. Patients exposed by inhalation who are
initially symptomatic should be observed carefully and reexamined
periodically. Patients who develop pulmonary edema should
be admitted to an intensive care unit.
Delayed Effects
Reactive airways dysfunction syndrome
(RADS) is a non-immune-mediated asthma-like syndrome that
can develop after exposure to sulfur dioxide. Once established,
this non-specific bronchial hyperreactivity might diminish
over a few weeks or persist for years. Bronchospasm might
be triggered in people who have chronic pulmonary diseases,
such as asthma and emphysema.
Patient Release
Patients who become totally asymptomatic
in terms of pulmonary complaints in a 6- to 8-hour observation
period are not likely to develop complications. They may be
released and advised to rest and to seek medical care promptly
if symptoms develop (see the Sulfur Dioxide-Patient Information
Sheet below). Cigarette smoking can exacerbate pulmonary
injury and should be discouraged for 72 hours after exposure.
Follow-up
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
Follow-up evaluation of respiratory
function should be arranged for severely exposed patients.
Patients who have skin or corneal lesions should be reexamined
within 24 hours.
Reporting
If a work-related incident has occurred,
you might be legally required to file a report; contact your
state or local health department.
Other persons might still be at risk
in the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
might prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace form the Occupational
Safety and Health Administration (OSHA) or the National Institute
for Occupational Safety and Health (NIOSH).
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
sulfur dioxide.
Print this handout only.pdf icon[52.8 KB]
What is sulfur dioxide?
Sulfur dioxide is a colorless gas that
has a strong, stinging odor. It has many industrial and agricultural
uses. Most sulfur dioxide comes from burning fossil fuels
containing sulfur and is a major part of air pollution. It
is shipped and handled as a compressed gas in a special container.
Some foods and wines are preserved with small amounts of sulfur
dioxide that are safe for most people.
What immediate health effects can be caused by exposure to sulfur dioxide?
Inhaling sulfur dioxide causes irritation
to the nose, eyes, throat, and lungs. Typical symptoms include
sore throat, runny nose, burning eyes, and cough. Inhaling
high levels can cause swollen lungs and difficulty breathing.
Skin contact with sulfur dioxide vapor can cause irritation
or burns. Liquid sulfur dioxide is very cold and can severely
injure the eyes or cause frostbite if it touches the skin.
Some people with asthma who are sensitive to sulfites might
have an asthma attack if they eat foods preserved with sulfur
dioxide or other sulfur-containing chemicals.
Can sulfur dioxide poisoning be treated?
There is no antidote for sulfur dioxide,
but its effects can be treated and most exposed persons recover
completely. Persons who have inhaled large amounts of sulfur
dioxide might need to be hospitalized.
Are any future health effects likely to occur?
A single, small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a serious exposure, damage to the
lungs can occur, causing asthma, pneumonia, and bronchitis.
Permanent damage to the lungs is possible.
What tests can be done if a person has been exposed to sulfur dioxide?
Specific tests for the presence of sulfur
dioxide in blood or urine are not generally useful. If a severe
exposure has occurred, blood analyses, x-rays, and breathing
tests might show whether the lungs have been injured. Testing
is not needed in every case.
Where can more information about sulfur dioxide be found?
If the exposure happened at work, you
might be required to contact your employer and the Occupational
Safety and Health Administration (OSHA).
Employees may request a Health Hazard
Evaluation from the National Institute for Occupational Safety
and health (NIOSH).
More information about sulfur dioxide
can be obtained from your regional poison control center;
your state, county, or local health department; the Agency
for Toxic Substances and Disease Registry (ATSDR); your doctor;
or a clinic in your area that specializes in occupational
and environmental health. Ask the person who gave you this
form for help locating these telephone numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only.pdf icon[52.8 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- eye, nose, throat irritation
- coughing or wheezing
- difficulty breathing or shortness of breath
- chest pain or tightness
- nausea, vomiting, diarrhea, or stomach pain
[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
[ ] Call for an appointment with Dr.____
in the practice of ________.
When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for _____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
[ ] Avoid taking the following medications:
________________
[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.