Suspect Hydrogen Sulfide Poisoning

Rapid "knock-down" effect. Rapid loss of consciousness. Blackening and/or darkening of pocket change and any jewelry items — watch, necklace, etc. Breath and body odor smell of rotten eggs. Low odor threshold: 0.02-0.13 ppm. Mucosal irritation: 50-150 ppm. Rapid olfactory fatigue and paralysis: 100-150 ppm, smell no longer appreciated.

Figure 22.4 The pathophysiology and management of cyanide or hydrogen sulfide gas poisoning. Restoring the disrupted cytochrome oxidase chain in cyanide and hydrogen sulfide gas poisoning with specific and shared treatment strategies.


Cytochrome oxidase chain



CN Poisoning

Nitrite therapy

Amyl (inhalation)

Sodium nitrite (iv)


CNHgb-Fe+3-No O2

Methylene blue therapy

Thiosulfate therapy

Rhodanase \Hydroxy-I cobalamin

Thiocyanate ltherapy [fj]


Oxyhemoglobin *

Cyanocobalamin Hgb-Fe+2-O2 (nontoxic vitamin B12)

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