Metabolic Toxins

Hydrogen sulfide is a colorless flammable gas that may be encountered in industry or as a natural product of organic decomposition, such as sewer or manure gas. The ability to detect its characteristic rotten egg odor is lost at high concentrations or with lengthy exposures to low concentrations. Its mechanism of toxicity is similar to that of cyanide, with disruption of oxidative phosphorylation through inhibition of cytochrome oxidase aa3. Cellular asphyxia and impaired ATP production promote anaerobic metabolism with lactate accumulation and metabolic acidosis. It is one of the few chemical asphyxiants that also possesses irritative properties, and respiratory and ocular irritation occur following exposure. In high concentrations, rapid loss of consciousness, seizures, and death may occur after only a few breaths. Delayed pulmonary edema and corneal destruction should be anticipated with massive exposures. Treatment involves decontamination of the skin and eyes as appropriate. Administration of the nitrite component of the cyanide antidote kit to promote low-level methemoglobin formation may result in conversion of sulfide to less toxic sulfmethemoglobin. Other treatments include 100% oxygen and possibly hyperbaric oxygen therapy. Other metabolic poisons such as carbon monoxide and cyanide are discussed in depth in Chap 182 and Chap 198.

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