A Fatal Case of Acute Hydrogen Sulfide Poisoning Caused by Hydrogen Sulfide: Hydroxocobalamin Therapy for Acute Hydrogen Sulfide Poisoning

Abstract

A patient committed suicide with hydrogen sulfide (H(2)S) by combining two commercial products. The patient was given hydroxocobalamin as an antidote in addition to treatment with cardiopulmonary resuscitation, but died approximately 42 min after his arrival at the hospital. The patient's cause of death was attributed to acute hydrogen sulfide poisoning. Serum concentrations of sulfide before and after administration of hydroxocobalamin were 0.22 and 0.11 μg/mL, respectively; serum concentrations of thiosulfate before and after hydroxocobalamin administration were 0.34 and 0.04 μmol/mL, respectively. Hydroxocobalamin is believed to form a complex with H(2)S in detoxification pathways of H(2)S. Although H(2)S is rapidly metabolized and excreted, the decreased sulfide concentration may be also associated with this complex formation. The decreased sulfide concentration suggests that hydroxocobalamin therapy may be effective for acute H(2)S poisoning. The decreased thiosulfate concentration seems to be associated with formation of a thiosulfate/hydroxocobalamin complex, because hydroxocobalamin can form a complex with thiosulfate. The thiosulfate concentration decreased to a greater extent than did sulfide, suggesting that hydroxocobalamin has a higher affinity for thiosulfate than for H(2)S. Therefore, prompt administration of hydroxocobalamin after H(2)S exposure may be effective for H(2)S poisoning.

Reversal of Heart and Respiratory Failure Following Accidental Exposure to Hydrogen Sulfide: Case Report

“…Anecdotal reports have mentioned the prompt use of hyperbaric oxygen therapy or hydroxocobalamin but these options remain controversial [18,19].…”

Efficacy of Intravenous Cobinamide Versus Hydroxocobalamin or Saline for Treatment of Severe Hydrogen Sulfide Toxicity in a Swine (Sus scrofa) Model

“…These trends are congruent with our experiments examining the efficacy of cobinamide to treat cyanide toxicity. 9 Although hydroxocobalamin has been shown to bind sulfide and thiosulfate, 22 it was not clinically effective in this model at the same mg/kg dose as cobinamide. This result is consistent with our previous work with cyanide where the effective hydroxocobalamin dose was about 5…”

“…22 Our intent in this experiment was to demonstrate that cobinamide is more efficacious compared to hydroxocobalamin on a mg/mg basis. We have previously shown that hydroxocobalamin is as effective as cobinamide in reversing cyanide toxicity but five times more hydroxocobalamin than cobinamide was required.…”

Guidelines for Burn Care Under Austere Conditions

“…70 The cyanide antidote hydroxocobalamin has also been used. 71,72 Some authors have proposed hyperbaric oxygen. 73 Anhydrous Ammonia (NH 3 ).…”