calcium-sulfide and Drug-Overdose

A-79-year-old woman ingested a cup of unknown violet agricultural solution intentionally. She was vomiting and smelt of sulfur. Arterial blood gas showed metabolic acidosis and marked cyanosis regardless of relatively high PaO2, caused by sulfhemoglobinemia. A nasogastric tube could not be inserted because of marked stenosis caused by endoscopically proven severe corrosive chemical injury (burn) of esophagus. Considering the smell and the clinical presentation, we concluded that the causative agent was calcium polysulfide or lime-sulphur solution, a common agricultural product used as a fungicide. Despite supportive therapy including infusion of NaNO2, the patient expired 4.5 hours after ingestion. Calcium polysulfide ingestions cause direct injury to the upper gastrointestinal tract, and react with gastric HCl producing poisonous H2S gas, which interferes cytochrome oxidase activity, developing tissue hypoxia, shock, and metabolic acidosis. Sulfhemoglobin is also produced causing severe cyanosis.

Topics: Aged; Burns, Chemical; Calcium Compounds; Drug Overdose; Esophageal Stenosis; Esophagitis; Esophagus; Fatal Outcome; Female; Fungicides, Industrial; Gases; Humans; Hydrogen Sulfide; Shock; Suicide, Attempted; Sulfhemoglobinemia; Sulfides; Thiosulfates

Calcium polysulfide or lime-sulfur solution is a common agricultural product used as a fungicide. Despite its easy availability, only two prior cases of intentional ingestion, both from Japan, have been reported in the literature.. Two cases of calcium polysulfide ingestion are presented. In the first case severe acidosis, coma and cardiac arrest occurred. Despite aggressive supportive therapy, the patient expired. Autopsy examination revealed hemorrhagic necrosis of the gastric mucosa. The second patient also exhibited altered mental status and metabolic acidosis. He experienced liver dysfunction, rhabdomyolysis, renal dysfunction, and aspiration pneumonia. He had endoscopically proven esophageal and gastric mucosal burns which developed into esophageal strictures.. Calcium polysulfide ingestions cause direct caustic injury to the upper gastrointestinal tract, coma and severe metabolic acidosis.

Topics: Acidosis; Adult; Autopsy; Calcium Compounds; Coma; Drug Overdose; Female; Fungicides, Industrial; Gastric Mucosa; Heart Arrest; Humans; Liver Failure; Male; Pneumonia; Renal Insufficiency; Rhabdomyolysis; Sulfides; Thiosulfates