Japanese experience of hydrogen sulfide: the suicide craze in 2008

Abstract

Most of hydrogen sulfide poisoning has been reported as industrial accidents in Japan. However, since January 2008, a burgeoning of suicide attempts using homemade hydrogen sulfide gas has become evident. By April 2008, the fad escalated into a chain reaction nationwide. Mortality of the poisoning was very high. There were 220 cases of attempted gas suicides during the period of March 27 to June 15, killing 208. An introduction of new method of making the gas, transmitted through message boards on the internet, was blamed for this "outbreak". The new method entailed mixing bath additive and toilet detergent. The National Police Agency instructed internet providers to remove information that could be harmful. Of the victims of the fad in 2008, several cases were serious enough that family members were involved and died. Paramedics and caregivers were also injured secondarily by the gas. This fad has rapidly spread by internet communication, and can happen anywhere in the world.

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

“…The precise nature of the toxic agent in this case remains uncertain since H 2 S laboratorial quantification was not available in our setting. Nevertheless, H 2 S has been described has the major toxic compound in sewer gas and the clinical picture was compatible to previously reported cases in literature [2][3][4][5]. Toxicological analysis of sulfide or thiosulphate (a metabolite of sulfide) in blood and urine of the patient would have been useful to definitely determine the poisoning substance and monitor the clinical course.…”

“…H 2 S is rapidly absorbed by the respiratory tract at concentrations of 250 ppm or higher and its direct toxicity result from induction of a hypoxic state due to respiratory blockade at a cellular level by inhibiting the mitochondrial cytochrome oxidase. Mental status depression and cardiac arrest within 30-60 minutes occur with exposure to concentrations above [4]. The precise nature of the toxic agent in this case remains uncertain since H 2 S laboratorial quantification was not available in our setting.…”

“…Under 100 ppm it may be sensed as a sweet odour. Outstandingly, its warning odour is lost at higher concentrations because of olfactory nerve paralysis [2][3][4][5]. H 2 S is rapidly absorbed by the respiratory tract at concentrations of 250 ppm or higher and its direct toxicity result from induction of a hypoxic state due to respiratory blockade at a cellular level by inhibiting the mitochondrial cytochrome oxidase.…”

“…It results from organic matter decomposition, industrial refinery or volcanic hot springs [2][3][4][5]. It has been referred to as the "knock down gas" because it can cause immediate loss of consciousness and death if inhaled in high concentrations [6,7].…”

“…Dramatically, 1007 cases of suicide attempts with H 2 S were reported in 2008 in Japan, presumably due to the availability of information of this substance over the internet regarding a new home-made method of making the gas [4,12]. Mortality varies from 2 to 6% according to different series [13].…”