Hydrogen sulphide inhalational toxicity at a petroleum refinery in Sri Lanka: a case series of seven survivors following an industrial accident and a brief review of medical literature

ABSTRACT: This case series details clinical observations in 7 survivors of accidental hydrogen sulphide inhalation toxicity at a petroleum refinery in Sri Lanka. One survivor developed status epilepticus and severe neurotoxicity whilst another survivor developed delayed respiratory failure; both patients required intensive care management. One victim manifested mild bronchospasms in the immediate post-exposure period and another developed mild perioral numbness 2 days following the exposure. A brief literature review explores the manifestations, pathophysiology and available modalities of treatment of hydrogen sulphide inhalation toxicity. BACKGROUND: Hydrogen sulphide (H(2)S) is a highly toxic gas. Accidental deaths following H(2)S exposure is a known hazard amongst petroleum workers exposed to by-products of refineries. Toxicity results mainly due to cellular respiratory poisoning which impairs oxidative phosphorylation. The heart, brain and the lungs are the organs most commonly affected in H(2)S inhalational toxicity leading to varied clinical presentations.