He was revived and Selleck Ku 0059436 then taken to hospital – his urinary thiosulphate was measured as 79 mmol/mol creatinine. Kage et al. (2002) reported an incident at an industrial waste pit where three men died after entering a pit (one

of whom died 22 days after the incident) and one worker survived. The delayed fatality and the survivor both had detectable levels of thiosulphate in urine in samples taken 2 h after the incident (1225 and 262 μmol/l, respectively, ∼102 and ∼22 mmol/mol creatinine – conversion assumes a mean creatinine concentration of 12 mmol/l, (Cocker et al., 2011)). Kage et al. (1997) reported an incident where four workers lost consciousness in an underground tank in a factory producing regenerated paper, all four workers recovered. Urinary thiosulphate selleck kinase inhibitor levels ranged from 120 to 430 μmol/l (∼10–36 mmol/mol creatinine), in samples taken 6 h post-incident and from <3 to 390 μmol/l (∼<0.3–∼33 mmol/mol creatinine), in samples taken 15 h post-incident. There are several reports in the literature of blood thiosulphate levels being detected after hydrogen sulphide fatalities (Table 1). The levels reported range between 25 (Kage et al., 1997) and 230 μmol/l (Kage et al., 2004). Rabbits that received a fatal dose of hydrogen sulphide (500–1000 ppm for up to 30 min) gave blood thiosulphate levels of 53–119 μmol/l (Kage et al., 1992), which is in good agreement with the human fatality

studies. Survivors of poisoning incidents are not reported to have detectable blood thiosulphate levels, as the body rapidly clears the blood, nor are 17-DMAG (Alvespimycin) HCl the general population. It has therefore been demonstrated, both within the case studies presented here and in the literature, that blood and/or urinary thiosulphate measurements can be useful in determining hydrogen sulphide as a potential cause of fatality or unconsciousness. The analysis is sufficiently sensitive to discriminate exposures from control samples and has reasonable specificity, if storage conditions are controlled. However, there are certain considerations

that need to be taken into account in order to get the most useful information from such analyses. First, the type of sample required will depend on the condition of the workers – if they are survivors of incidents then urine samples are most appropriate as the body will rapidly clear any thiosulphate from the blood. In the case of fatalities (to determine likely cause of death or to assist in any related investigation), blood samples are most appropriate. Urine samples may be useful as additional samples to ascertain whether death was instantaneous or delayed after a period of unconsciousness, especially if the worker was not discovered until sometime after the incident. Secondly, the timing of the sample relative to the incident is important for detecting exposures in survivors.