emDocs - eptember 14, 2016 - Authors: Patrick C Ng and Brit Long
Edited by: Alex Koyfman and Stephen Alerhand
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.