OCCUPATIONAL FATALITY AND PERSISTENT NEUROLOGICAL SEQUELAE AFTER MASSEXPOSURE TO HYDROGEN-SULFIDE

Exposure to hydrogen sulfide (H2S) has been associated with death as w ell as survival following coma with or without hypoxic brain damage. T he release of H2S at a beachfront construction site led to the emergen cy evaluation and treatment of 37 people, with six admissions and one death. At least one victim, who underwent extensive therapy with hyper baric oxygen, developed persistent neurological sequelae. Despite incr eased awareness of the potentially life-threatening consequences of ex posure to H2S, significant poisoning continues to occur, even in work places where the hazards are well-known and can be avoided. Recommende d therapy includes nitrites, hyperbaric oxygen, and supportive care, b ut documentation of efficacy is lacking. Because patients with chronic neurological sequelae after acute H2S exposure continue to be reporte d, we suggest that any survivor of H2S poisoning who presents in coma or who manifests objectively verifiable evidence of neurotoxicity on p hysical examination or lab testing should undergo baseline and annual neurological and neuropsychological testing for at least five years. T his approach could standardize and enhance our knowledge of, and abili ty to defect, the subtle but permanent alterations of central nervous system function that follow H2S exposure. ((C) 1995 by W.B. Saunders C ompany)