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viernes, 16 de septiembre de 2016

Hydrogen Sulfide Toxicity

emDocs - eptember 14, 2016 - Authors: Patrick C Ng and Brit Long
Edited by: Alex Koyfman and Stephen Alerhand
screen-shot-2016-09-13-at-1-24-06-pm
Summary
  • Hydrogen sulfide exposures can be deadly.
  • Hydrogen sulfide exposures can happen in various industrial settings as well as in the home as a suicide attempt.
  • Removal of the patient from the exposure as soon and as safely as possible is a key initial step.
  • Aggressive supportive care is the mainstay of treatment.
  • Sodium nitrite and other nitrite formulations can be used to induce a methemoglobinemia to treat H2S toxicity. Hyperbaric oxygen, methylene blue, and hydroxocobalamin have also been used.
  • There is no consensus on dosing of sodium nitrite, and one must consider the drug’s side effects including hypotension.
  • Cobinamide, a hydroxocobalamin derivative, may serve as an effective intramuscular antidote for H2S toxicity in the future.