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Suicide With Hydrogen Sulfide

Sams, Ralph Newton MD*; Carver, H. Wayne II MD; Catanese, Charles MD; Gilson, Thomas MD

The American Journal of Forensic Medicine and Pathology: June 2013 - Volume 34 - Issue 2 - p 81–82
doi: 10.1097/PAF.0b013e3182886d35
Case Reports

This presentation will address the recent rise of suicide deaths resulting from the asphyxiation by hydrogen sulfide (H2S) gas.

Hydrogen sulfide poisoning has been an infrequently encountered cause of death in medical examiner practice. Most H2S deaths that have been reported occurred in association with industrial exposure.

More recently, H2S has been seen in the commission of suicide, particularly in Japan. Scattered reports of this phenomenon have also appeared in the United States.

We have recently observed 2 intentional asphyxial deaths in association with H2S. In both cases, the decedents committed suicide in their automobiles. They generated H2S by combining a sulfide-containing tree spray with toilet bowl cleaner (with an active ingredient of hydrogen chloride acid). Both death scenes prompted hazardous materials team responses because of notes attached to the victims’ car windows indicating the presence of toxic gas. Autopsy findings included discoloration of lividity and an accentuation of the gray matter of the brain. Toxicology testing confirmed H2S exposure with the demonstration of high levels of thiosulfate in blood.

In summary, suicide with H2S appears to be increasing in the United States.

From the *Department of Pathology, Rhode Island Hospital–Brown University School of Medicine, Providence, RI; †Office of the Chief Medical Examiner, Farmington, CT; and ‡Orange County Medical Examiners Office, Goshen, NY.

Manuscript received September 1, 2011; accepted October 20, 2011.

This article was presented at the 2010 National Association of Medical Examiners Annual Meeting and was awarded the 2010 John Smialek Best Resident Paper Award.

The authors report no conflicts of interest.

Reprints: Ralph Newton Sams, MD, Department of Pathology, Rhode Island Hospital, 593 Eddy St, APC-12 Providence, RI 02903. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.