Date: Sun, 28 Mar 2010 12:56:20 -0600
Reply-To: DCHAS-L Discussion List <DCHAS-L**At_Symbol_Here**LIST.UVM.EDU>
Sender: DCHAS-L Discussion List <DCHAS-L**At_Symbol_Here**LIST.UVM.EDU>
From: Alan Hall <ahalltoxic**At_Symbol_Here**MSN.COM>
Subject: Re: H2S Antidotes
In-Reply-To: <4D683A6055DEC24DBF97B58C0CE7C070029DBA4F**At_Symbol_Here**>

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  (Note:  the 7th edition is in pre paration, but will not be published for some time yet).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 H. Hall, M.D.
Medical Toxicologist
Laramie, WY
Clinical Assistant Professor
Coloraro School of Public Health
Denver, CO
Cell Phone:  (307) 399-1564

Date: Sat, 27 Mar 2010 10:07:45 -0500
From: rlcook**At_Symbol_Here**MARATHONOIL.COM
Subject: Re: [DCHAS-L] H2S Antidotes
To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU

To clarify my earlier respons e, hydrogen sulfide paralyzes the pherinic nerve resulting in the cessati on of breathing. Due to this action, there is no appreciable build-up of the gas in the body, as would be the case with hydrogen cyanide. Therefor e the person dies of asphyxiation not chemical poisoning, so restoration of the breathing function and administration of oxygen will revive the vict im.

There is varied research on any long term after effects of expos ure, but the important thing is survival of the victim. The brain O2 defi ciency problem still applies.


Ray Cook, Jr., C IH, CSP
Regards, Ray - from my BB

From: DCHAS-L Discussion List <DCH AS-L**At_Symbol_Here**LIST.UVM.EDU>
To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU <DCHAS-L**At_Symbol_Here**L IST.UVM.EDU>
Sent: Fri Mar 26 21:41:07 2010
Subject: Re: [DCHAS-L] H2S Antidotes

If still breathing, adminis ter oxygen, if not CPR, then oxygen.

Regards, Ray - from my BB

From: DCHAS-L Discussion List <DCH AS-L**At_Symbol_Here**LIST.UVM.EDU>
To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU <DCHAS-L**At_Symbol_Here**L IST.UVM.EDU>
Sent: Fri Mar 26 18:49:17 2010
Subject: [DCHAS-L] H2S Antidotes

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

 < /FONT>


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