Medical Management Guidelines for Hydrogen Sulfide
(H
2S)
CAS# 7783-060-4
UN# 1053
PDF Versionpdf icon[203 KB]
Synonyms include dihydrogen sulfide,
sulfur hydride, sulfurated hydrogen, hydrosulfuric acid, "sewer
gas," "swamp gas," hepatic acid, sour gas,
and "stink damp."
- Persons exposed to hydrogen sulfide pose no serious risks
of secondary contamination to personnel outside the Hot
Zone. However, fatalities have occurred to rescuers entering
the hot zone.
- Hydrogen sulfide is a colorless, highly flammable and
explosive gas produced naturally by decaying organic matter
and by certain industrial processes. Hydrogen sulfide has
a characteristic rotten-egg odor; however, olfactory fatigue
may occur and consequently it may not provide adequate warning
of hazardous concentrations.
- Hydrogen sulfide is well absorbed through the lungs; cutaneous
absorption is minimal. Exposure by any route can cause systemic
effects.
General Information
Description
Hydrogen sulfide is a colorless, flammable,
highly toxic gas. It is shipped as a liquefied, compressed
gas. It has a characteristic rotten-egg odor that is detectable
at concentrations as low as 0.5 ppb.
Routes of Exposure
Inhalation
Inhalation is the major route of hydrogen
sulfide exposure. The gas is rapidly absorbed by the lungs.
The odor threshold (0.5 ppb) is much lower than the OSHA ceiling
(20 ppm). However, although its strong odor is readily identified,
olfactory fatigue occurs at high concentrations and at continuous
low concentrations. For this reason, odor is not a reliable
indicator of hydrogen sulfide's presence and may not provide
adequate warning of hazardous concentrations. Hydrogen
sulfide is slightly heavier than air and may accumulate in
enclosed, poorly ventilated, and low-lying areas.
Children exposed to the same levels
of hydrogen sulfide as adults may receive larger doses 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 hydrogen
sulfide found nearer to the ground. Children may be more vulnerable
to corrosive agents than adults because of the relatively
smaller diameter of their airways.
Skin/Eye Contact
Prolonged exposure to hydrogen sulfide,
even at relatively low levels, may result in painful dermatitis
and burning eyes. Direct contact with the liquefied gas can
cause frostbite. Absorption through intact skin is minimal.
Ingestion
Because hydrogen sulfide is a gas at
room temperature, ingestion is unlikely to occur.
Sources/Uses
Hydrogen sulfide is produced naturally
by decaying organic matter and is released from sewage sludge,
liquid manure, sulfur hot springs, and natural gas. It is
a by-product of many industrial processes including petroleum
refining, tanning, mining, wood- pulp processing, rayon manufacturing,
sugar-beet processing, and hot-asphalt paving. Hydrogen sulfide
is used to produce elemental sulfur, sulfuric acid, and heavy
water for nuclear reactors.
Standards and Guidelines
OSHA ceiling = 20 ppm
OSHA maximum peak = 50 ppm (10 minutes,
once, no other exposure)
NIOSH IDLH (immediately dangerous to
life or health) = 100 ppm
AIHA ERPC-2 (emergency response planning
guideline) (maximum airborne concentration below which it
is believed that nearly all individuals could be exposed for
up to 1 hour without experiencing or developing irreversible
or other serious health effects or symptoms which could impair
an individual's ability to take protective action) = 30 ppm.
Physical Properties
Description: Colorless gas with
odor of rotten eggs
Warning properties: Not dependable;
characteristic rotten-egg odor detectable at about 0.5 ppb,
but olfactory nerve fatigue occurs in 2 to 15 minutes at concentrations
over 100 ppm
Molecular weight: 34.1 daltons
Boiling point (760 mm Hg): -77°F
(-60.3°C)
Vapor pressure: >760 mm Hg
at 68°F (20°C)
Gas density: 1.2 (air = 1)
Water solubility: Slightly water
soluble (0.4% at 68°F [20°C])
Flammability: Highly flammable
and explosive between 4% and 45% (concentration in air); may
travel to a source of ignition and flash back. Burns to produce
a toxic gas, sulfur dioxide.
Incompatibilities
Hydrogen sulfide reacts with strong oxidizers,
strong nitric acid, and metals.
Health Effects
- Hydrogen sulfide is a mucous membrane and respiratory
tract irritant; pulmonary edema, which may be immediate
or delayed, can occur after exposure to high concentrations.
- Symptoms of acute exposure include nausea, headaches,
delirium, disturbed equilibrium, tremors, convulsions, and
skin and eye irritation.
- Inhalation of high concentrations of hydrogen sulfide
can produce extremely rapid unconsciousness and death. Exposure
to the liquified gas can cause frostbite injury.
Acute Exposure
Hydrogen sulfide's can cause inhibition
of the cytochrome oxidase enzyme system resulting in lack
of oxygen use in the cells. Anaerobic metabolism causes accumulation
of lactic acid leading to an acid-base imbalance. The nervous
system and cardiac tissues are particularly vulnerable to
the disruption of oxidative metabolism and death is often
the result of respiratory arrest. Hydrogen sulfide also irritates
skin, eyes, mucous membranes, and the respiratory tract. Pulmonary
effects may not be apparent for up to 72 hours after exposure.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
CNS
CNS injury is immediate and significant
after exposure to hydrogen sulfide. At high concentrations,
only a few breaths can lead to immediate loss of consciousness,
coma, respiratory paralysis, seizures, and death. CNS stimulation
may precede CNS depression. Stimulation manifests as excitation,
rapid breathing, and headache; depression manifests as impaired
gait, dizziness, and coma, possibly progressing to respiratory
paralysis and death. In addition, decreased ability to smell
hydrogen sulfide occurs at concentrations greater than 100
ppm.
Respiratory
Inhaled hydrogen sulfide initially affects
the nose and throat. Low concentrations (50 ppm) can
rapidly produce irritation of the nose, throat, and lower
respiratory tract. Pulmonary manifestations include cough,
shortness of breath, and bronchial or lung hemorrhage. Higher
concentrations can provoke bronchitis and cause accumulation
of fluid in the lungs, which may be immediate or delayed for
up to 72 hours. Lack of oxygen may result in blue skin color.
Children may be more vulnerable to corrosive
agents than adults because of the relatively smaller diameter
of their airways. Children may also be more vulnerable to
gas exposure because of increased minute ventilation per kg
and failure to evacuate an area promptly when exposed.
Cardiovascular
High-dose exposures may cause insufficient
cardiac output, irregular heartbeat, and conduction abnormalities.
Renal
Transient renal effects include blood,
casts, and protein in the urine. Renal failure as a direct
result of hydrogen sulfide toxicity has not been described,
although it may occur secondary to cardiovascular compromise.
Gastrointestinal
Symptoms may include nausea and vomiting.
Dermal
Prolonged or massive exposure may cause
burning, itching, redness, and painful inflammation of the
skin. Exposure to the liquified gas can cause frostbite injury.
Ocular
Eye irritation may result in inflammation
(i.e., keratoconjunctivitis) and clouding of the eye surface.
Symptoms include blurred vision, sensitivity to light, and
spasmodic blinking or involuntary closing of the eyelid.
Potential Sequelae
Inflammation of the bronchi can be a
late development. Survivors of severe exposure may develop
psychological disturbances and permanent damage to the brain
and heart. The cornea may be permanently scarred.
Chronic Exposure
Hydrogen sulfide does not accumulate
in the body. Nevertheless, repeated or prolonged exposure
has been reported to cause low blood pressure, headache, nausea,
loss of appetite, weight loss, ataxia, eye-membrane inflammation,
and chronic cough. Neurologic symptoms, including psychological
disorders, have been associated with chronic exposure. Chronic
exposure may be more serious for children because of their
potential longer latency period.
Carcinogenicity
Hydrogen sulfide has not been classified
for carcinogenic effects.
Reproductive and Developmental Effects
There is some evidence to suggest that
exposure to hydrogen Developmental Effects sulfide may be
associated with an increased risk of spontaneous abortion.
No information was located pertaining to placental transfer
of hydrogen sulfide or to excretion of hydrogen sulfide in
breast milk. There are no studies of developmental effects
in humans exposed to hydrogen sulfide. However, results from
animal studies suggest that hydrogen sulfide may be a developmental
neurotoxicant. Hydrogen sulfide is not listed in TERIS or
in Shepard's Catalog of Teratogenic Agents. It is also
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.
Prehospital Management
- Victims exposed only to hydrogen sulfide gas do not pose
substantial risks of secondary contamination to personnel
outside the Hot Zone. However, personnel could be secondarily
contaminated by contacting or breathing vapors from clothing
heavily soaked with hydrogen sulfide-containing solution.
- Hydrogen sulfide is a highly toxic gas that can produce
extremely rapid CNS and respiratory depression. It is also
an irritant affecting skin and mucous membranes.
- There is no proven antidote for hydrogen sulfide poisoning.
Treatment generally 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 prehospital staff have not been trained
in its use, assistance should be obtained from a local or
regional HAZMAT team or other properly equipped response organization.
Rescuer Protection
Hydrogen sulfide is an extremely rapidly
acting, highly toxic gas. Fatalities have occurred to rescuers
entering the hot zone.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of hydrogen sulfide.
Skin Protection: Chemical-protective
clothing is not generally required because hydrogen sulfide
gas is not absorbed through the skin, and skin irritation
is rare. Direct contact with the liquefied gas can cause frostbite.
Rescuers should have a safety line during
rescue operations because of the extremely rapid toxic action
of hydrogen sulfide.
ABC Reminders
Quickly access for a patent airway, ensure adequate
respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may 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 hydrogen sulfide
gas who have no skin or eye 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 worn in the Hot Zone
(described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Remove and double-bag contaminated
clothing.
Handle frostbitten skin and eyes with
caution. Wrap the affected part gently in blankets. Let the
circulation reestablish itself naturally. Encourage the victim
to exercise the affected part while it is being warmed.
Flush exposed skin and hair with water
for 3 to 5 minutes. Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers
when appropriate.
Do not irrigate frostbitten eyes. Otherwise,
irrigate exposed or irritated eyes with plain water or saline
for at least 5 minutes. Eye irrigation may be carried out
simultaneously with other basic care and transport. Remove
contact lenses if easily removable without additional trauma
to the eye. If a corrosive material is suspected or if pain
or injury is evident, continue irrigation while transferring
the victim to the support zone.
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.
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 properly
decontaminated (see Decontamination Zone above). Victims
who have undergone decontamination or who have been exposed
only to hydrogen sulfide gas pose no serious risks of secondary
contamination. 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). Hydrogen sulfide 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
according to advanced life support (ALS) protocols.
If frostbite is present, treat by rewarming
in a water bath at a temperature of 102 to 108°F (40
to 42°C) for 20 to 30 minutes and continue until a flush
has returned to the affected area.
Nitrite therapy (found in the cyanide antidote kit) has been
suggested as a therapy for hydrogen sulfide exposure. Amyl
nitrite is given by inhalation (for 30 seconds every minute
until an intravenous line is established) followed by intravenous
sodium nitrite (300 mg over absolutely no less than 5 minutes).
This may aid recovery by forming sulfmethemoglobin, thus removing
sulfide from combination in tissue. It is not necessary to
use the sodium thiosulfate component of the cyanide antidote
kit. The antidotal efficacy of nitrite therapy is controversial,
but is currently recommended if it can be started shortly
after exposure. However, there is only anecdotal evidence
that nitrite therapy is effective, and victims of hydrogen
sulfide poisoning have survived without sequelae after supportive
care alone. The usefulness of nitrite therapy given beyond
the first few minutes after exposure is questionable. Nitrite
therapy should not be allowed to interfere with the establishment
of adequate ventilation and oxygenation.
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 to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
Multi-Casualty Triage
Consult with the base station physician
or regional poison control center for further advice regarding
triage of multiple victims.Patients with evidence of significant
exposure (e.g., breathing difficulties, unconsciousness, seizures,
or collapse) should be transported to a medical facility for
evaluation. Patients who have minor or transient irritation
of the eyes or throat may be discharged from the scene after
their names, addresses, and telephone numbers are recorded.
They should be advised to seek medical care promptly if symptoms
develop or recur (see Patient Information Sheet below).
Emergency Department Management
- Hospital personnel away from the scene are not at risk
of secondary contamination from patients exposed only to
hydrogen sulfide gas; however, personnel can be secondarily
contaminated by contacting or breathing vapors from clothing
heavily soaked with hydrogen sulfide-containing solution.
- Hydrogen sulfide is a very rapidly acting, highly toxic
gas that can produce rapid CNS and respiratory depression.
It is also an irritant affecting skin and mucous membranes.
- There is no proven antidote for hydrogen sulfide poisoning.
Treatment generally consists of support of respiratory and
cardiovascular functions.
Decontamination Area
Patients who have been decontaminated
previously and patients exposed only to hydrogen sulfide gas
who have no skin or eye irritation may be transferred immediately
to the Critical Care Area. Other patients 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.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. Children may be more vulnerable to corrosive
agents than adults because of the smaller diameter of their
airways. 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). Hydrogen sulfide 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 have seizures or ventricular arrhythmias should be treated
in the conventional manner.
Nitrite therapy (found in the cyanide
antidote kit) has been suggested as a therapy for hydrogen
sulfide exposure. Amyl nitrite is given by inhalation (for
30 seconds every minute until an intravenous line is established)
followed by intravenous sodium nitrite (300 mg over absolutely
no less than 5 minutes). This may aid recovery by forming
sulfmethemoglobin, thus removing sulfide from combination
in tissue. It is not necessary to use the sodium thiosulfate
component of the cyanide antidote kit. The antidotal efficacy
of nitrite therapy is controversial, but is currently recommended
if it can be started shortly after exposure. The usefulness
of nitrite therapy given beyond the first few minutes after
exposure is questionable. There is only anecdotal evidence
that nitrite therapy is effective, and victims of hydrogen
sulfide poisoning have survived without sequelae after supportive
care alone. Nitrite therapy should not be allowed to interfere
with the establishment of adequate ventilation and oxygenation.
Basic Decontamination
Patients who are able may assist with
their own decontamination. Remove and double-bag contaminated
clothing and personal belongings.
Handle frostbitten skin and eyes with
caution. Place frostbitten skin in warm water, about 108°F
(42°C). Let the circulation reestablish itself naturally.
Encourage the victim to exercise the affected part while it
is being warmed.
Flush exposed skin and hair with plain
water for 5 minutes, preferably under a shower. Use caution
to avoid hypothermia when decontaminating children or the
elderly. Use blankets or warmers when appropriate.
Do not irrigate frostbitten eyes. Otherwise,
irrigate exposed eyes for at least 5 minutes. Remove contact
lenses if easily removable without additional trauma to the
eye. An ophthalmic anesthetic may be necessary to alleviate
blepharospasm, and lid retractors may be required to allow
adequate irrigation under the eyelids. Continue irrigation
while transporting the patient to the Critical Care Area.
Critical Care Area
Be certain that appropriate decontamination
has been carried out (see Decontamination Area above).
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Children
may be more vulnerable to corrosive agents than adults because
of the smaller diameter of their airways. Establish intravenous
access in seriously symptomatic patients. Continuously monitor
cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory symptoms. 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). Hydrogen
sulfide 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.
Observe patients for 24 hours, repeating
appropriate tests and chest examinations as needed. Follow-up
as clinically indicated.
Skin Exposure
If concentrated hydrogen sulfide was
in contact with the skin, chemical burns may result; treat
as thermal burns. If the liquefied compressed gas is released
and contacts the skin, frostbite may result. If a victim has
frostbite, treat by rewarming affected areas in a water bath
at a temperature of 102 to 108°F (40 to 42°C) for
20 to 30 minutes and continue until a flush has returned to
the affected area.
Eye Exposure
Continue irrigation for at least 5 minutes.
Test visual acuity. Examine the eyes for corneal damage and
treat appropriately. Immediately consult an ophthalmologist
for patients who have severe corneal injuries.
Antidotes and Other Treatments
Nitrite therapy (found in the cyanide
antidote kit) has been Other Treatments suggested as a therapy
for hydrogen sulfide exposure. Amyl nitrite is given by inhalation
(for 30 seconds every minute until an intravenous line is
established) followed by intravenous sodium nitrite (300
mg over absolutely no less than 5 minutes). This may aid
recovery by forming sulfmethemoglobin, thus removing sulfide
from combination in tissue. It is not necessary to use the
sodium thiosulfate component of the cyanide antidote kit.
The antidotal efficacy of nitrite therapy is controversial,
but is currently recommended if it can be started shortly
after exposure. The usefulness of nitrite therapy given beyond
the first few minutes after exposure is questionable. There
is only anecdotal evidence that nitrite therapy is effective,
and victims of hydrogen sulfide poisoning have survived without
sequelae after supportive care alone. Nitrite therapy should
not be allowed to interfere with the establishment of adequate
ventilation and oxygenation.
Hyperbaric oxygen therapy is controversial
and based on anecdotal evidence. It may be effective for patients
with persistent coma in whom other treatments are unsuccessful.
Laboratory Tests
Routine laboratory studies for all symptomatic
exposed patients include CBC, blood glucose, and electrolyte
determinations. Additional studies for patients exposed to
hydrogen sulfide include ECG monitoring and renal-function
tests. Chest radiography and pulse oximetry (or ABG measurements)
may be helpful in cases of inhalation exposure. If nitrites
are used, check methemoglobin levels.
Disposition and Follow-up
Consider hospitalizing patients who have evidence of
systemic toxicity from any route of exposure.
Delayed Effects
Patients who are unconscious or hypotensive
should be observed closely for complications including post-hypoxic
encephalopathy. Because pulmonary edema may be delayed in
onset, patients seriously exposed by inhalation should be
monitored for 24 hours. If pulmonary edema is suspected, admit
patients to an intensive care unit.
Patient Release
Asymptomatic patients who have no evidence
of pulmonary edema or CNS or respiratory compromise and no
signs of eye irritation may be discharged after 4 to 6 hours
of observation with instructions to seek medical care promptly
if symptoms develop (see the Hydrogen Sulfide-Patient Information
Sheet below).
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.
Patients exposed to hydrogen sulfide
should be monitored for heart and brain injuries, including
evaluation for neurologic deficits.
Patients who have skin or corneal injury
should be re-examined within 24 hours.
Reporting
If a work-related incident has occurred,
you may be legally required to file a report; contact your
state or local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may 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 from OSHA or
NIOSH. See Appendices III and IV for a list of agencies that
may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
hydrogen sulfide.
Print instructions only.pdf icon[PDF - 44.2 KB]
What is hydrogen sulfide?
Hydrogen sulfide is an extremely rapidly
acting, highly toxic, colorless gas with a rotten-egg odor.
It is produced naturally by decaying organic matter and is
released from sewage sludge, liquid manure, sulfur hot springs,
and natural gas. It is used in several industries and is a
by-product of many industrial processes such as oil refining,
mining, and rayon manufacturing.
What immediate health effects can be caused by exposure to hydrogen sulfide?
Even in small amounts, hydrogen sulfide
has a strong rotten-egg odor. However, with continued exposure
and at high levels, the poison may deaden a person's sense
of smell. If the rotten egg odor is no longer noticeable,
it may not necessarily mean that exposure has stopped.
After a serious exposure, symptoms usually
begin immediately. At low levels, hydrogen sulfide causes
irritation of the eyes, nose, and throat. Moderate levels
can cause headache, dizziness, nausea, and vomiting, as well
as coughing and difficulty in breathing. Higher levels can
cause shock, convulsions, coma, and death. Generally, the
more serious the exposure, the more severe the symptoms.
Can hydrogen sulfide poisoning be treated?
There is no proven antidote for hydrogen
sulfide poisoning, but the effects of hydrogen sulfide can
be treated and some exposed persons get well. Persons who
have had serious exposures may 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. Moderate exposure can cause residual damage
and a serious exposure that causes coma or convulsions may
damage the brain and heart.
What tests can be done if a person has been exposed to hydrogen sulfide?
Specific tests for the presence of hydrogen
sulfide in blood and urine generally are not useful to the
doctor. If a severe exposure has occurred, blood and urine
analyses and other tests may show whether the brain, nerves,
heart, or kidneys have been injured. If hydrogen sulfide was
inhaled, blood tests and a chest x-ray may be necessary to
determine if the lungs have been injured. Testing is not needed
in every case.
Where can more information about hydrogen sulfide be found?
More information about hydrogen sulfide
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. If the exposure happened at work,
you may wish to discuss it with your employer, the Occupational
Safety and Health Administration (OSHA), or the National Institute
for Occupational Safety and Health (NIOSH). Ask the person
who gave you this form for help in 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[PDF - 44.2 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- coughing, wheezing, difficulty breathing, or shortness
of breath
- chest pain or tightness
- stomach pain, or vomiting
- headache
- increased redness or pain or a pus-like discharge in the
area of a skin burn
[ ] 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.