One was unconscious on admission. Both provided urine samples whilst at the hospital – worker 1 (male, 53 years old) approximately 9 h after the incident, worker 2 (male, 54 years old) at an unknown time (but apparently the same day) by catheter as he was still unconscious. The urine sample for worker 1 contained 326 μmol/l thiosulphate (23 mmol/mol creatinine), which is consistent with the levels seen in other survivors of reported incidents of hydrogen sulphide exposure where samples have been taken between 2 and 15 h of the incident (Kage et

al., 1997 and Kage et al., 2002). Worker 2’s result (10 μmol/l, 2 mmol/mol creatinine) was within previously reported background levels (Kangas and Savolainen, 1987 and Chwatko and Bald, 2009) however it is not clear when the sample was Afatinib price collected in relation to the incident. It is possible that, if he was exposed, it might take a couple of hours for his thiosulphate level to exceed background levels (as demonstrated by a volunteer study (Kangas and Savolainen, 1987)); so if the sample was taken shortly after the incident, the sample may not reflect

the extent of his exposure to hydrogen Selleckchem Cabozantinib sulphide. Equally, if the sample had been taken later, the level of thiosulphate may already have reduced to background levels. There is previously reported, (Kage et al., 1997) a case (in which a man lost consciousness due to hydrogen sulphide exposure and subsequently recovered) where the urinary thiosulphate level was less than 3 μmol/l when the sample was taken 15 h after the incident. There was evidence that worker 1 had been exposed to hydrogen sulphide in sufficient amounts to cause a feeling of unwellness or even unconsciousness. The sample of worker 2 did not demonstrate evidence

of hydrogen sulphide exposure but this does not exclude the possibility of exposure due to the unknown timing of sample collection. A chicken waste Pyruvate dehydrogenase lipoamide kinase isozyme 1 rendering plant had a blocked condenser connected to a storage vessel. On releasing the blockage, an emission of gas (suspected to contain hydrogen sulphide) was released knocking three workers unconscious. All three workers were taken to hospital, two were subsequently released and one spent time in intensive care before being released. Blood samples were obtained from two of the workers (both male, ages unknown) but were not detectable for thiosulphate. This is in agreement with previous reports where blood thiosulphate is not detected in survivors of hydrogen sulphide incidents. Unfortunately, in this case, it was not possible to obtain urine samples. Samples of the chicken waste showed considerable potential for hydrogen sulphide generation at the sterilising temperature used (∼120 °C). One urine sample and one blood sample were received from a fatality (male, age unknown) involving a biodigester, where hydrogen sulphide was a suspected toxic agent. The urine sample was below the detection limit for thiosulphate.